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What is Psoriasis? 

Psoriasis is a condition where the body makes new skin cells in days rather than weeks. The skin cells pile up on the surface of the skin leading to thick scaly plaques. These plaques can show up anywhere on the body but typically favor the scalp, knees, elbows and lower back. Without proper treatment, these plaques can cause intense itching, pain and burning.

Is psoriasis curable?

Most people who get psoriasis have it for life. Psoriasis is not curable, however, with appropriate treatment, psoriasis in controllable. By gaining control, you can see clearer (or clear) skin. Your dermatologist will work with you in educating you on triggers, routine skin care, lifestyle changes and how to use your prescribed medication. 

In addition, Psoriasis can increase your risk of developing certain diseases, such as psoriatic arthritis or diabetes. Your dermatologist can watch for early signs of disease. If you do develop another disease, early treatment helps to prevent the disease from worsening.

Sign and symptoms:

Dry, thick, and raised patches on the skin are the most common sign of psoriasis. These patches are often covered with a silvery-white coating called scale, and they tend to itch.

Types of psoriasis:

Plaque psoriasis: Plaques usually form on the scalp, elbows, knees, or lower back; however, they can develop anywhere on the skin. Scratching can cause the patches to thicken. 

Guttate psoriasis: With this type of psoriasis, tiny red bumps appear on the skin quite suddenly. The bumps tend to cover much of the trunk and extremities. 

Palmoplantar psoriasis: Occurs on the palms or soles of the feet and can make just about any activity that requires your hands or feet, such as typing or walking, unbearably painful.

Erythrodermic psoriasis: Serious and life-threatening, this type of psoriasis requires immediate medical care. When someone develops erythrodermic psoriasis, you may notice skin on most of the body looks burnt and constitutional symptoms such as fever and chills. The person may also be unable to keep warm, so hypothermia can set in quickly.

Psoriatic arthritis: If you have psoriasis, it’s important to pay attention to your joints. This is more likely to occur if you have severe psoriasis.

Nail Psoriasis: When psoriasis affects the nails, you may notice: dents in the nails, white/yellow discoloration, crumbling nails or nail lifting. 

How do we treat psoriasis? If you have psoriasis, a dermatologist can create a treatment plan to meet your individual needs. To create this plan, your dermatologist will consider the: Type(s) of psoriasis you have, places psoriasis appears on your body, severity of the psoriasis, impact psoriasis has on your life and other medical conditions you have. 

PSORIASIS affects

So which retinoid is the best for you?

You constantly hear that vitamin A is the go-to ingredient for fighting fine lines and wrinkles, dark spots and clearing up skin.  We would certainly agree, but with all the products containing variations of vitamin A, prescription and non-prescription, it's easy to get confused about which is right for you. Retinoids, retinol, retinoic acid, Retin-A, Renova, and Tazorac (and the list goes on) are all forms of vitamin A or contain derivatives of this nutrient found naturally in the skin, but what's the difference between them all?  Read on for a crash course in retinol to clear up this common confusion.

First, let’s start with retinoids, which is the general, all-encompassing term for a class of chemical compounds related to vitamin A.  Retinoids are used in various skin and beauty related products and treatments to address issues from acne to wrinkles. Retinoic acid, which is the main active ingredient of the prescription drugs Retin-A, Renova and Tazorac, is the real star when it comes to treating acne and aging skin.

Now on to retinol, which is a type of retinoid that is usually found in non-prescription wrinkle creams. Retinol found in many over the counter skin-care products can convert retinoic acid, but the operative word is can. The conversion is not predictable, so just because a product contains retinol, it doesn't mean that it can or will do what retinoic acid can do in terms of acne or even as a wrinkle treatment.  The most important factors that determine this are: how the formula is made, the percentage used, how it’s delivered into the skin, and how stable it is.  Good brands and formulations you can trust are available which is why when it comes to this ingredient you want to purchase a product from a physician or knowledgeable skincare professional.  

So which retinoid is the best for you? That depends on your concerns and your type of skin.  The skin's reaction is determined by the chemical variations and molecular structure of the retinoid product.  Generally prescription formulas are best for treating acne and suited for oily, tolerant skin.  Skin sensitivity is a major factor.  If you ARE sensitive the prescription is not best for you. Most people do have a certain degree of skin sensitivity which is why its can be a good idea to start with a non-prescription retinol first, eventually transitioning to using a prescription.  With that said, if you have any of the following conditions: 

  • Comedonal acne – This is the type of acne that appears as whiteheads, blackheads, closed comedones and clogged non-inflamed bumps.  Retinoids restore the organization of cells through cell turnover, in turn, preventing cells from getting trapped and blocked in the pore lining which is what causes those little non-infected bumps. 
  • Premature aging -  Someone over age 35 with a long history of sun damage (hello Florida sun!).  You may feel like your skin shows more visible signs of aging than other people your age.
  • Scarring – Someone who, regardless of age, has pitted, indented facial scarring from acne in your younger years
  • Melasma – Dark brown spots or patches from the sun, heat, pregnancy or hormones will benefit from something stronger to work deeper and faster.  However keep in mind that retinoids will make your skin more sensitive to the sun so daily sunscreen with diligent reapplication if very important.  Also, expectant mothers should avoid any Vitamin A products during pregnancy. 

Skip a prescription and go straight to a retinol if you’re:

  • Some one who, regardless of age, has thin, dry and or sensitive skin.  This includes rosacea, a history of eczema or simply easily irritated skin types.  While most skin’s will develop a tolerance to retinoids with continued use, these skin types may never adjust to a prescription due to the skins easily compromised, delicate barrier.
  • Someone under age 35 with no major acne issues who would like to prevent wrinkles, lighten discoloration, reduce pore size and smooth texture.  Sticking with retinol and occasional peels is perfect because you’re getting ahead of the aging process. There’s not as much repair work to do in those younger than 35.
  • Someone over the age of 35 who is interested in trying retinol for the first time and wants to start slowly. 

We have addressed the what and who, but when and how should retinol be used?  While the exact age can vary depending on skin type, typically between the ages of 26-30 is a good time to start using retinol to prevent the appearance of lines and wrinkles.   Vitamin A can speed up the skin’s turnover which begins to slow in your early 30’s.  When you’re younger your skin is already very metabolically active.  Using retinol too early might actually stir up breakouts, rashes and more by disrupting the skin’s natural balance.  As for how to use it, I typically recommend starting by using a thin layer on clean, dry skin, 2-3 times per week gauging your sensitivity and working up to 5 nights a week. If you’re experiencing dryness or irritation you may be using too much or using it too often, remember, using retinol successfully is a marathon, not a sprint. Avoid applying moisturizer immediately after application of your retinol, which could dilute it slightly.  While that can sometimes aid in tolerability, it’s generally best to let it absorb for 20 minutes before continuing with your regimen.   Retinol in and of itself is photosensitive, breaking down when exposed to sunlight in addition to increasing your skin's sensitivity to harmful UV rays, so the general rule with retinoids is to use them at night.

At Paradise Dermatology we offer a formula called Retinol Complete which is encapsulated and time-released and formulated with antioxidants, so it not only boosts skin’s radiance but also enhances it overall condition! Whether you are a newbie or a veteran, it’s a good idea to examine your retinol options and make sure you are using the best formula for you in the correct way for optimal results!  Please visit us for a 15-minute complementary consultation so we can assess your specific concerns and needs and set you on the right retinol path. 

Common scalp issues and how to treat them

Scalp skin is unique on the body due to the bulk of hair follicles and high amount of sebum(oil) production. These features make it vulnerable to fungal conditions, parasitic infestation, and inflammatory conditions. Because these scalp conditions share similar signs and symptoms of scaling, inflammation, hair loss, and itching, getting the correct diagnosis is important. Let’s discuss the most common scalp conditions and the best methods for treatment.

1. Psoriasis: Pink plaques with silvery scales

Psoriasis is an autoimmune condition where the cells are in overdrive leading to a build up of skin cells creating scaly patches that can itch, hurt and even bleed. The treatment is about relieving symptoms as psoriasis is controllable not curable. The first line treatment is to start with steroids, while tougher situations may require injections called biologics that help to suppress what's causing the flare ups. But you should also take in account your hair care routine as many shampoos can improve the rash and heat treatments such as blow-drying can worsen your psoriasis.

2. Folliculitis: Scattered pus bumps

Folliculitis is an inflammation of the hair follicle. It can be caused by a bacteria infection, shaving, excessive sweating and tweezing. It will appear as small bumps scattered over the scalp like acne. They can cause soreness and itching. The treatment can vary depending on the cause of the rash. First line treatments include a topical (liquid) or oral antibiotic followed by a steroid cream to help if the inflammation persists.

3. Seborrheic Dermatitis: Greasy scale and dandruff

Seborrhea is one of the most common scalp conditions. Cradle cap in babies turns into itchy patches with greasy scale or dandruff in an adult. It isn't contagious but can be embarrassing. Unfortunately, it often comes and goes with triggers such as stress and seasonal changes (winter and early spring). Aside from the scalp, the face, ears, and chest can also be affected. Although no definitive cause has been identified, a yeast (fungus) called malassezia that is in the oil secretion on the skin, seems to be the most likely culprit. Some predisposing factors include Parkinson's, depression, diabetes, a weakened immune system, and obesity. We recommend treating early and aggressively to avoid complications such as hair loss. Often a prescription strength anti-yeast shampoo called ketoconazole will help in addition to a topical steroid if itching persists.

4. Alopecia: Hair loss

Hair loss can be due to several factors, including medications, genetics, inflammation and hormone issues. If you notice hair breaking/shedding or bald spots on your scalp, it is important to get evaluated by a medical professional. After an in-depth discussion, it is helpful to run blood work to evaluate for anemia, vitamin deficiency, thyroid abnormalities, hormone levels, and autoimmune markers.

If blood tests are all normal, other sources of stress such as the death, pregnancy and surgery can cause some shedding months after the incident. However, most of the time, it’s due to the aging process and hormone levels. Woman’s estrogen levels decrease, and often, so does our hair. It also may be the toll of years of bleaching, dyeing, straightening, perming, and wearing tight pony tails.

The treatment is geared to correcting any medical abnormalities if they present themselves. Underlying scalp conditions such as seborrheic dermatitis or psoriasis should be addressed. In the case of hormonal thinning, there are treatments such a Rogaine, a solution that thickens existing hair can help. Eating a well-balanced diet, filled with vitamins such as B12, folate, and biotin are also useful when experiencing hair shedding. Lastly, taking a break from over-processing your hair is encouraged. In extreme cases, hair transplant or PRP is an effective option.

5. Ringworm: Scaly rash and bald spots
Also called tinea capitis, its most common in children but occasionally occurs in adults. The most common ways we contract the fungus is: Human to human, animal to human (cats are a common source), and object to human (clothing, towels, bedding/ linens, combs, and brushes). The resulting rash is usually painful and scaly. It also can cause bald spots, broken hairs, and black dots. The most effective treatment is taking an antifungal pill. Treating or discarding infected sources can help to prevent re-infection.

Skin Biopsy Procedure - What to Expect

A skin biopsy is a procedure in which a dermatologist cuts and removes a small sample of skin to have it tested. This sample may help your dermatologist diagnose diseases such as skin cancer, rashes, infection, or other skin disorders. Done under local anesthesia in the office, the procedure is quick and relatively painless.

First, the skin is sanitized with alcohol or another antiseptic. Then a small amount of numbing medicine is injected into the skin surrounding the spot to be biopsied. At most, you’ll feel a minor burning sensation for 10 seconds as the anesthesia is injected. Then, the biopsy procedure will be performed.

There are several types of skin biopsies including:

Shave biopsy: The top layer of skin is shaved off with a small blade. This procedure is generally used to diagnose nonmelanoma skin conditions such as actinic keratosis and basal and squamous cell carcinoma. A deeper shave biopsy called a "scoop" or "saucer" shave biopsy is sometimes used to rule out a melanoma. Stitches are not required and bleeding is minimal.

Punch biopsy: The doctor uses a tool that looks like a tiny round cookie cutter to remove a deeper layer of the skin. If a large sample is taken, one or two stitches may be needed.

Incisional vs. excisional biopsy: An incisional biopsy involves removing a small sample of a lesion with a scalpel. An excisional biopsy removes the entire lesion with a scalpel. Stitches are used to close the wound.

During these procedures, there is usually a small amount of bleeding. This is stopped using cautery, a small electrical current that closes the wound or sometimes aluminum chloride is applied to the wound to stop bleeding. Then a layer of Vaseline is applied and a bandage. Some biopsies require sutures but most do not. Healing occurs in 1 to 2 weeks.

Biopsies are mainly performed to determine whether a lesion is cancerous, precancerous, or benign. By examining the biopsied specimen under a microscope and using special stains, the dermatopathologist can give a more exact diagnosis than is possible with physical examination alone.

What to Expect After a Skin Biopsy

After the skin biopsy is done you may have some soreness around the biopsied site for a few days. Tylenol is usually sufficient to relieve any discomfort. If you had stitches after the procedure, keep the area as clean and as dry as possible. Your doctor will tell you when the stitches should be removed. You should expect a small scar from the biopsy.

What Is Done With a Skin Biopsy Sample?

The tissue is processed, and a dermatopathologist examines the skin biopsy sample under a microscope to determine if there is any disease. The results usually come back within one to two weeks.

When Should I Call the Doctor After a Skin Biopsy?

Call your doctor if you have bleeding that can't be stopped by applying pressure or any signs of infection such as redness, warmth, pus, or red streaks. Also call if you have any questions or concerns after a skin biopsy.

 

Could Microneedling be your favorite cosmetic treatment?

Microneedling is a minimally invasive treatment in which tiny punctures are created in the skin using micro-fine needles (from 0.5 to 2 millimeters in diameter). This treatment triggers the body’s natural wound healing process, resulting in cell turnover and stimulating collagen and elastin production, reversing as well as preventing signs of aging. Though the treatment is appropriate for many different skin types, it is important to let a professional decide whether or not it’s right for you. Some skin conditions such as active acne and pustular rosacea as well as illnesses that involve issues with wound healing are contraindicated. With that said, whether your skin has texture to it due to large pores, acne scars or fine lines or you’re looking for a rejuvenating anti-aging boost, this treatment is ideal. We’ve seen some great results with melasma, a type of hyperpigmentation commonly seen in women that can be due to hormonal influences when microneedling treatments were used in conjunction with topical medications at home.

We have received great feedback regarding the results of this treatment! Here’s what one of our patients said about microneedling and melasma…”Microneedling has been my favorite cosmetic treatment. I have struggled with melasma for years. After only 2 treatments, I saw results. Not only did it help with the melasma, but it has also made my skin tone and texture amazing.” Microneedling is a great alternative to laser for patients who aren’t candidates for laser treatments or a great adjunct therapy as maintenance. Here’s what another Paradise patient had to say…”This is the only treatment that has given my skin immediate, visible results. Now after three treatments, I have improvement in the fine lines around my eyes and in the brown sun damaged spots on my cheeks. The biggest change was to the overall texture of my skin- it looks and feels significantly smoother. And my skin continues to improve. I am hooked!”

While results vary from person to person, improvement can be seen as soon as 2 weeks after the procedure with results continuing up to 8 months post-procedure as collagen is produced cyclically and builds up over time. We generally see marked improvement around 4-6 weeks after the second treatment and recommend at least 2 and up to 6 sessions. At Paradise Dermatology we offer individual microneedling sessions starting at 250.00 but also have a package of 3 available, which offers a per treatment savings. Human growth hormone and topical post procedure serums are available to maximize your results. You may have heard of microneedling referred to as the “vampire facial”. While we do bring the skin to pinpoint bleed, the procedure itself is very comfortable, as your skin will be numbed topically. You might experience a bit of redness immediately following the treatment and some dryness and tightness for a few days following, but once it subsides, you’ll notice a dewy, glowy complexion and a new plumpness to your skin! Check out our spring microneedling special and try this amazing treatment today.

Teen Acne Do's and Don'ts

Teen acne is a skin condition causing bumps on the face, back, and chest. Oil glands make a natural moisturizer for your skin, called sebum. In teen acne, sebum can clog the pores, which makes the skin "sticky" and difficult to shed. The combination of sebum, dead skin cells, and bacteria within a clogged pore causes a pimple.

Teen acne can affect a young person's outlook on life, social adjustment, and even school performance. Today we know that pimples can cause scarring not just on the skin, but also on the psyche. Recent studies show that teen acne can result in a loss of self-esteem and self-confidence, poor body image and social withdrawal, and, depression, anger, and frustration. Fortunately, we have improved our ability to manage and treat these patients.

Do’s & Don’ts

  • Do : make sure teens rinse with water that is warm. Use mild cleansers such as Cetaphil or Cerave.
  • Don’t: scrub with a washcloth; use fingertips and wash the face gently.
  • Do: use your acne medication only as directed by your doctor
  • Don’t: use over-the-counter acne treatments in addition to your prescriptions without checking with your doctor
  • Do: look for products that are non-comedogenic and oil-free
  • Don’t: use more makeup than you need. Do apply makeup after you put on your acne medication and remove your makeup every night with gentle cleansing
  • Do: take caution with applying hair products. If they get into contact with the face, they may further clog pores and make your acne flare. If you are a teen who has started to shave, use care to avoid nicking pimples; an electric razor may work better than a razor blade to avoid spreading the bacteria.

 

What Happens to Your Skin During Pregnancy

A GUIDE TO SKINCARE DURING PREGNANCY

Pregnancy can be a time of excitement and happiness but also uncertainty, especially when it comes to skincare. Nowadays there are a multitude of sources for information on how to keep mom healthy and baby safe from books to magazine articles and of course the internet. While useful, after all knowledge is power, sometimes it can be overwhelming, confusing and even misleading. So you’ve heard of that pregnancy glow but skin conditions such as acne, heightened sensitivity and pigment issues are concerns that plague many. The struggle is real, mamas! To help you navigate the beauty minefield that pregnancy presents, here's an overview of what happens to your skin and how best to treat it.

The problem: The mask of pregnancy

Coupled with increased photosensitivity, you can experience a surge in pigment-stimulating hormones while pregnant and these can contribute to melasma – large patches of discoloration appearing on the face. While some of the tried and true solutions for pigment issues such as laser and chemical peels should be avoided as well as the skin lightening ingredient hydroquinone, topical vitamin C is an excellent alternative. Vitamin C delivers more than just brightening benefits. It plays crucial role in collagen production and acts as an antioxidant, protecting cells from free radical damage. Our Revision Vitamin C 30% lotion will give your skin a glow pregnant or not! It's also extra important to be sun-safe during pregnancy. Broad spectrum physical sunscreens that block both UVA and UVB rays are great to protect without chemicals that absorb into the skin and cause irritation. One of my favorites is EltaMD’s UV Pure is good for both face and body, offers SPF 47 and is water resistant. We also carry Elta’s UV Physical, a tinted version for the face.

The problem: Hormonal Acne

With fluctuating hormone levels, an increase in oil production and anxiety added into the mix, many women break out during pregnancy, especially around the chin, jawline and cheeks. While you may want to stay away from traditional acne remedies containing benzoyl peroxide, retinol and salicylic acid, alpha hydroxy acids such as glycolic and lactic acids as well as natural enzymes can be well tolerated and have been shown to be safe. Facial treatments at Paradise Dermatology are personalized to treat your skin safely and effectively while providing relaxation and rest. Products like EltaMD Foaming Facial Cleanser, a gentle cleanser that foams to loosen makeup, oil, and other impurities on the skin and in the pores, and Avene Skincare’s Clean-AC cream work to clean, soothe and hydrate the skin without causing additional breakouts.

The Problem: Heightened sensitivity

Hormonal Changes in pregnancy can also increase skin sensitivities, making you more sun sensitive and exacerbating skin conditions such as eczema and rosacea. Additionally, when pregnant the volume of blood in the body increases often tipping that healthy glow into redness. Using a product such as Colorescience All Calm, a chemical free mineral SPF 50 with soothing agents to calm skim and a tinted redness-neutralizing base gives you several solutions in one easy step. Simplicity and efficiency is essential for busy moms! In the office, calming treatments that include LED light therapy and facial lymphatic massage work wonders to relax your skin and you too!

The Problem: Drier Skin

While hormonal changes cause some women’s skin to become oiler, for others dryness can occur. Also, credit a loss of bodily fluids which are traveling from you to baby and your skin can become more reptilian than radiant. Besides drinking plenty of water, using a hyaluronic acid serum such as Revision’s Hydrating Serum can help your skin retain moisture. HydraFacial treatments can be customized for expectant and nursing moms to give skin a major hydrating boost.

INGREDIENTS TO AVOID

While you might find many ingredients that can be used safely during pregnancy, there are various ingredients – both natural and synthetic- that are completely advised against during pregnancy and nursing. Below is a list and where you might find them.

  • Prescription Medication – Most prescription topicals are not safe during pregnancy and possibly nursing. Check with your medical provider.
  • Vitamin A/Retinol – All retinod products should be avoided during pregnancy as some studies have linked them to birth and child defects.
  • Phthalates/formaldehyde/toluene – Look out for these chemicals in perfume and nail polishes as they have been linked to hormonal disruption in some studies. With limited data, adverse effects on the fetus cannot be ruled out.
  • Ammonia – Found in some hair dyes. Your colorist should be able to advise you on ammonia-free options and at what point it is safe to color your hair.
  • Dihydroxyacetone (DHA) – DHA is the active ingredient in self tanning products. While it is considered safe by some to use self tanning creams or lotions, scientists are still unclear as to how much absorption of this ingredient is possible through the skin. It is best to avoid spray tanning as inhalation is a concern. Since the effects of DHA on the pregnancy are not known and it has not been proven safe during pregnancy, it’s a good idea to steer clear.
  • Certain Essential Oils – There are many natural and organic products that are gentle and have wonderful benefits for you skin during pregnancy, however certain essential oils should be avoided as they can encourage uterine contractions, adversely affect your baby in its early developmental stages and decrease milk production. Diffusing oils aromatically is a safe way to enjoy their therapeutic benefits during pregnancy.

If you are expecting a new little bundle in your life, congratulations and good luck! My best advice is to relax and enjoy the ride. As a mother of 2, I can vouch for the old saying that in parenthood…the days are long, but the years are short.

 

 

Is Dermatology Covered By Insurance
Dermatology is a mainstream medical specialty. Thousands of people visit a dermatologist every day for common and uncommon skin issues. Like traditional health care, most services a dermatologist offers are covered by insurance. However, medications, procedures, and some conditions won’t be payable by health insurance.
 
The guideline insurance companies use to determine whether they will pay for a service or not is medical necessity. Medical necessity has been a controversial topic for decades, so it’s always a good idea to read your policy and refer to it several times a year.
 
To be considered medically necessary, the visit must be to evaluate, diagnose, or continue treating a medical condition. Dermatologists spend most of their time treating more serious skin conditions. Most of the conditions and procedures listed below are considered medically necessary. A list of the most commonly covered conditions is listed below.
  • Skin cancer
  • Rashes
  • Psoriasis
  • Port wine stain removal
  • Hemangioma excision
  • Acne
  • Skin or fungal infections
  • Eczema
  • Warts
  • Hives
  • Skin allergies
  • Keloid scars
  • Shingles
In most situations, an elective or cosmetic procedure is not covered by health insurance because it is not medically necessary, which means a person’s overall health is not affected if the person does not receive the treatment. There may be exceptions, but it is very unlikely.

Even if you are convinced that your insurance will cover your dermatology visit, you still need to make sure you have a referral, if needed. Some insurance companies require their subscribers to receive a referral from a primary care physician before seeing a specialist. If a referral is not secured before a specialist visit, the dermatology appointment may not be covered or paid at a lower rate.

If you are referred to a dermatologist and already have insurance, you need to make sure the physician is covered under your plan before you make an appointment. If you can’t find a dermatologist in your area, you can contact the insurance company directly for a referral.

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Many of our patients come in for skin checks and have one or more skin biopsies (samples) performed to determine if a suspicious lesion is benign or malignant. How do we determine which lesions are worrisome? What elements of the patient’s history make us concerned for a malignant lesion? What does it mean when we reassure you that a lesion is benign? What about a malignant lesion – how worried should you be?

A benign lesion or tumor is a noncancerous growth. Non-cancerous means it is unable to spread throughout the body. Benign lesions can be removed if they are irritated or bothersome, otherwise they are harmless.

A malignant tumor has the ability to grow uncontrollably, metastasize (spread) to other areas of the body and invade normal surrounding tissue. Malignant tumors can bypass the body’s normal mechanisms to control cell growth and spread. As malignant tumor invades surrounding tissue and spread to other areas of the body, they cause destruction along the way.

The most common malignant tumor of the skin is a basal cell carcinoma. They are locally destructive but rarely metastasize. They create a slow growing, non-healing sore on the skin. If left untreated they can be disfiguring and painful. Recently there has been much debate whether these “slow growing, nonlethal cancerous lesions” are being overtreated, especially in the elderly. I know I opted for more conservative treatments in my elderly patients and often deferred treatment if the lesions are small and not bothersome.

One of the less common but more dangerous malignant tumor of the skin is melanoma. Even small lesions with no symptoms can eventually metastasize and be fatal. Many of my patients come in for other concerns like itchy rashes or sore, rough spots and we incidentally find a melanoma on their back or leg. This is why I encourage all my patients to have a once a year full body skin check. The most dangerous skin lesions are not necessarily the ones that bother them!

What types of lesions should you be worried about?

  • New or changing mole or one that looks different than other moles
  • Non-healing sore or sore that heals and returns
  • Brown or black streak under a nail
  • Dome shaped growth
Skincare Ingredients Perfect for Sensitive Skin

If you have sensitive skin purchasing skincare products can seem overwhelming and scary. Knowing what to look for and what to avoid is important. Using treatments and products that focus on improving the skin barrier, moisture, and nutrients can be very beneficial for sensitive skin. In order to keep the skin healthy and still get results with other concerns like wrinkles, dryness, and blemishes you need to know what ingredients are safe to use. Here are a few that you should look for when reading labels on products.

Chamomile is probably one of the first things that comes to mind when you think of ingredients that soothe. A natural anti-inflammatory and antiseptic, chamomile can prevent infection by neutralizing germs on the skin which in turn helps reduce the severity of inflammatory conditions like eczema and acne.

Aloe Vera is one of nature’s purest moisturizers. On contact with the skin it instantly cools and soothes irritation, reduces redness and hydrates even the driest skins. I It is lightweight enough to be used on all skin types and can be found in many lotions, not just in the traditional gel form.

Oatmeal is a great skin soother and natural exfoliator. Oatmeal can gently buff away dead skin cells while also hydrating the skin to leave you with a smoother, softer complexion. It also helps to reduce inflammation caused by acne and eczema, making it a multi-tasking sensitive skin must-have.

Vitamin E is a very versatile ingredient, powerful antioxidant that protects and heals sensitive skin types. The antioxidant properties defend the skin against harmful free- radicals which can cause wrinkles so that skin stays looking younger for longer. Vitamin E will also regulate the moisture levels in the skin to reduce inflammation.

Glycolic acid is effective on all skin types. Found naturally in sugarcane and fruits including grapes, glycolic acid is a popular ingredient found in cleansers designed for dry skin. Glycolic acid exfoliates and helps to attract moisture to your skin and keep your face hydrated throughout the day.

Urea is a little-known ingredient used to dramatically soften the skin. Urea is humectant- it draws moisture from the air to hydrate the skin. It is a great additive to your skin in improving the appearance of KP or Keratosis Pilaris.

Please keep in mind, as sensitive skin comes in many forms, always be careful when trying out new skincare products. While the ingredients mentioned here may be low risk, you should still be careful when using any new products for the first time, even if they have been created for sensitive skin. Finally, remember to avoid anything that contains harsh chemicals, fragrances, and artificial colors as these are the biggest irritators for sensitive skin. If you are still feeling unsure call our office for a complimentary consultation with our Medical aesthetician, Lily. She will work with you to come up with a regimen that works best for you and your skin.

GLYCOLIC VS. SALICYLIC ACIDS - WHICH ONE IS RIGHT FOR YOU?

Any time we start discussing the best ways to exfoliate the skin, it’s not long before the ingredients glycolic acid and salicylic acid come up. Glycolic acid is an AHA, or alpha-hydroxy acid, and salicylic acid is a BHA, or beta-hydroxy acid. Both of them work extremely well at making skin look more even, brighter and refreshed.

But which one is right for your skin?

Both ingredients work as chemical exfoliators that loosen the “glue-like” substance that holds our skin cells together.  This allows dead skin cells to slough off more easily revealing smoother, healthier skin and keeping pores from becoming blocked.

How they work varies a bit though, that’s why the decision to use glycolic acid versus salicylic acid really depends on what type of skin you have…

Because glycolic acid is the AHA with the smallest molecule, it penetrates the skin more deeply and easily than other acids. That means it is more effective at the things we need it to do like exfoliate, improve fine lines and stimulate the production of collagen and elastin. Glycolic acid is best for sun-damaged, mature, and dry skin…helping to reduce the signs of premature aging and rejuvenating the skin but it can also be an effective acne treatment. Because it releases and dissolves blackheads and minimizing the appearance of pores, it can also be an effective acne treatment, It works particularly well on cystic acne, which is caused by deep blockages of dead skin and sebum.

On the other end of the spectrum, salicylic acid is better for those with oily, acne-prone skin or those with sensitive skin.

The reason is, salicylic acid gets through oil that clogs pores. It is the only acid that can penetrate oil, because it is fat-soluble. All other acids are water-soluble. Thanks to this property, it can reach *inside* a pore and exfoliate the lining of the pore wall. This loosens and allows the contents of the pore to flow out more freely. It not only clears existing blackheads but also prevents new ones from forming, improving the lining of larger pores that can be more prone to acne.  Another plus, this acid has anti-inflammatory and mildly anti-bacterial action – both of which are great for oily, acneic skin. All-in-all, salicylic acid is a great exfoliator that can improve skin thickness, improve barrier function and stimulate collagen production.

There are a range of over the counter products available. Cleansers can be left on for a few minutes and washed off so they are great for sensitive skins while wipes, toners and lotions that can be left on all day or night yield excellent results with consistent use. The newest additions to our product selection are Paradise Dermatology Acne Wash and Acne Pads. Formulated with 5% glycolic and 2% salicyclic acid, these products are an effective and affordable solution for tween, adolescent and adult patients. We’ve already gotten some great feedback from patients!

Hopefully now you have a better idea of which of these acids is right for your skin. Whichever you choose to use, the key to optimizing skin health is seeing a skin care professional. By combining a customized at-home regimen with powerful in office treatments and targeted solutions, the result is healthier, skin with visible improvement in acne, congestion, fine lines, wrinkles and other signs of aging.

 PD October Blog Image Skin

Interesting Facts About Your Skin!

Your skin is the human body’s largest organ.
Skin accounts for about 15% of your body weight.
The average adult skin weighs approximately 9 lbs.
Your skin is its thickest on your feet (1.4mm) and thinnest on your eyelids (0.2mm).
You renew your skin every 28 days.
When you get a sunburn, it’s not your skin cells being damaged by the sun and dying, it’s your skin cells’ DNA being damaged by the sun and them killing themselves so they don’t turn into cancer
Your skin constantly sheds dead cells, about 30,000 to 40,000 cells every minute.
It is estimated that at least half of the dust in your home is actually dead skin.
Scar tissue lacks hair and sweat glands
Sweat is odorless, it’s the bacteria that produces body odor
Your skin contains more than 1,000 species of bacteria.
On average, 14 types of fungi species grow in between your toes.
It takes 6 months for babies to form their natural skin tone

PD October Blog Image Milia

What are Milia?

Milia are tiny white bumps or cysts that appear under the skin. These bumps are often confused with acne, but they are really a completely different type of skin breakout. They are typically one to two millimeters(1-2 mm) in size and can show up as single bump or in clusters. Milia are most common in newborns but many adults and children suffer from them as well. They are not contagious and are painless and completely harmless.

How to treat Milia?

Although milia are found in the outer layers of skin, they are difficult to remove without the proper tools. Do not try to remove them at home, as you may leave a scar. Milia are best treated in a dermatology office or by a licensed Aesthetician. The practitioner will create an opening in the above layer of skin and express the milium contents. Although it sounds invasive, milia extractions are rather quick and pain free. If you are prone to milia, a topical retinoid may be prescribed to help decrease the frequency of break outs.

Lilys Shelfie with logo

My current am routine is Revision Vitamin C 30% lotion with intellishade original over it. That gives me sun protection, a little bit of coverage and a healthy glow. I use the colorescience corrector kit ( I use the brush provided in the kit and a larger fluffier one to conceal and contour). My last step is a spray toner to set it and lip balm. I love the Colorescience SPF 50 powder for my neck and chest which gives me coverage and doesn't get all over my necklace or my clothes.

I love to dermaplane my skin monthly and apply an oil like NIA 24 Treatment Catalyst. Also love doing weekly treatment masks like Revision's Black Mask to purify my skin or Eminence Organics HOT Blueberry Detox mask which exfoliates and stimulates major circulation.

I try to massage coconut oil with essential oils (typically rosemary) on my scalp monthly to condition it and promote hair growth. It smells so good!

Eye creams from NeoCutis, NIA24 help soften fine lines and wrinkles and brighten my eye area.

Ice is a quick and totally cheap way to reduce puffiness and wake up your face. I ice my face all the time! When you have a headache applying it to your neck at the base of your skull relieves pain so miraculously!!

August Blog Image Acne
What is acne?

Acne, also known as acne vulgaris, is thought to be caused by multiple factors. Overproduction of a normal oil on the skin, increases under the influence of hormones. This, coupled with insufficient shedding of dead skin cells, plugs hair follicles. The plugged follicle can become inflamed and have increased growth of normal skin bacteria, Propionibacterium acnes.

Who’s at risk?

Acne affects 85–100% of people at some point in their lives, and it usually begins at puberty. Acne can persist into the 30s and beyond. In fact, 5% of people over 45 still have acne.

What are signs and symptoms of acne?

Acne results in a variety of lesions. The most common acne locations include the face, neck, chest, and back, where the most sebaceous glands are located. Along the jaw line is a common location in adults.

Acne can result in permanent scars, which can appear to be depressions in the skin or hyperpigmentation, which is dark red or brown flat marks where the acne lesions were.

When to seek professional help?

If you have moderate or severe acne that has not improved enough with self-care, seek medical help.

What are treatment options for my acne?

Topical (or external) treatments for acne include one or more creams, washes, or gels that include:

  • Antibacterial agents and antibiotics such as benzoyl peroxide, clindamycin, erythromycin, sulfur, sodium sulfacetamide, and azelaic acid.
  • Retinoids – vitamin A-derived products such as tretinoin, tazarotene, and adapalene.

Oral treatments may include:

  • Antibiotics such as tetracycline, minocycline, doxycycline, erythromycin, ampicillin, clindamycin, trimethoprim-sulfamethoxazole, azithromycin, or cephalosporins.
  • Oral contraceptives and spironolactone have been found to help regulate hormones.
    Isotretinoin, a strong drug with many side effects, for severe acne unresponsive to the above treatments.
What to Look For in a Good Sunblock

Hyperpigmentation such as age spots, acne scars, and melasma are darkened spots or patches on the skin. It is caused by an overproduction of melanin. Sun exposure is the main cause of overproduction of melanin in the skin. It can also occur after damage to the skin by conditions such as acne and eczema or injury such as a burn and after picking at the skin. Although no one likes to hear it, aging skin is also more prone to hyperpigmentation in the form of "age spots."

Prevention is key! All causes of hyperpigmentation are affected and worsened by sun exposure, therefore a good sunblock is essential. The American Academy of Dermatology recommends looking for 3 essential traits when shopping for sunblock.
1. SPF 30 or higher
2. Broad spectrum protection (UVA/UVB)
3. Water resistance
In general mineral based sunblocks offer superior protection with less sensitivity. These sunblocks contain zinc oxide and titanium dioxide. The EltaMD brand of sunblock offered at Paradise Dermatology contain these ingredients and offer sun protection without clogging your pores. For acne prone skin or for the active person concerned about sweat, the ColorScience mineral powdered sunblock is a favorite at Paradise Dermatology.
To help minimize the appearance of hyperpigmented spots one of the many options is the Sciton BBL photofacial. With fast results and minimal downtime the BBL treatment can help reduce the appearance of hyperpigmentation and also redness on the face.
As always, ask your specialist at Paradise Dermatology what you can do to keep your skin healthy and youthful!

Preventing Hyperpigmentation

While living in paradise has its advantages, most of us struggle with the effects of the hot, sunny climate and the Florida lifestyle on our skin. A common issue facing most people is hyperpigmentation. This is because hyperpigmentation is most often caused by UV exposure.

Hyperpigmentation is a usually harmless condition in which patches of skin become darker in color than the normal surrounding skin. This darkening occurs when an excess of melanin, the brown pigment that produces normal skin color, forms deposits in the skin. UV stimulates the pigment cells (melanocytes) in our epidermis to start making melanin. Sadly, most of the hyperpigmentation you have now you probably actually earned 20 years ago. It takes an average of 10 years for sun damage to translate into brown spots and it’s just being encouraged and worsened by current UV exposure.

There are other causes worth mentioning, including heat, hormones and injury or trauma to the skin known as post inflammatory hyperpigmentation (PIH). While these can and usually do have other contributing factors all types of hyperpigmentation will benefit from following the steps below to manage and improve the condition.

  1. PROTECTION: It’s absolutely imperative to protect your skin from UV rays. When staying out of peak sun is not an option, wear hats and sun protective clothing and wear a broad-spectrum sunscreen that protects from UVA and UVB. Today there are a wide variety of formulations from clear to tinted lotions, powders, water resistant formulas, natural sun blocks and sprays. One of my favorite products is Colorescience Sunforgettable SPF 50, a brush on mineral powder that makes reapplication super easy. Remember sunscreens only last a couple of hours!
  2. ACTIVE TOPICALS WITH NATURAL LIGHTENERS: Skin-brightening products use antioxidant vitamins and plant based extracts that not only improve hyperpigmentation but also deliver anti-aging benefits and boost skin function and health. Look for ingredients such as Vitamin C, licorice root, kojic acid, bearberry extract (alpha arbutin) and Niacinimide that work by inhibiting tyrosinase, the enzyme responsible for the formation of skin darkening melanin and/or lightening skin. Nia 24 Sun Damage Repair for Décolletage and Hands contains Pro-Niacin (Vitamin B3) and a plant based brightening complex to visibly improve the appearance of sun damage on the chest, shoulders, hands and arms. As for Vitamin C, don’t miss Revision’s 30% Vitamin C lotion! It’s one of our most popular products.
  3. VISIT AN AESTHETICIAN: In office treatments such as HydraFacial, Dermaplane and Microneedling are excellent for lightening, brightening and tightening your skin as well as improving the penetration of your products. Come in for a complementary cosmetic consultation to talk about the best options available for your skin or take advantage of our 95.00 SUMMER HydraFacial Special and enjoy an amazing treatment while we analyze and get to know your skin.
  4. SEE A MEDICAL PROFESSIONAL REGULARLY: Your using a high quality Vitamin C, skin brightening and hydrating ingredients, and enjoying regular skin treatments and your skin’s appearance has really improved but you’re still dealing with stubborn discoloration. High potency lighteners such as Hydroquinone can be prescribed for maximum benefit. Paradise Dermatology Rebritaylize Pads are compounded in the office in 2%, 4% and 6% formulations. Advanced treatment such as laser is non-invasive and over the course of several sessions gives excellent results! Annual skin checks are a good idea for everyone and if in doubt it’s always best to check it out with a medical professional.

Mole blog image

Mole or Melanoma?

Summer is fast approaching and that means more fun in the sun! It is time to get sun-smart to prevent UV radiation from causing skin cancer. It is estimated that one in five Americans will be diagnosed with skin cancer. Melanoma is a type of skin cancer that develops from changes in our melanocytes, the pigment producing cells in our skin. Melanoma can occur anywhere on the body. If left untreated, melanoma can spread to organs inside the body and ultimately lead to death. Melanoma is estimated to claim 10,000 American lives this year and is considered the most deadly type of skin cancer. However, if detected early, melanoma can be easily treated with a five-year survival of 98%! It is important to check yourself monthly and receive annual full body skin exams.

Sun exposure is the most preventable risk factor for melanoma. It is recommended that you use an SPF of 30 or greater daily and to reapply often. Other risk factors for the development of melanoma include light skin and hair, many moles or freckles, those with a 1st degree relative with the diagnosis of melanoma, a personal history of a previous melanoma, or immune suppression. Melanoma is usually black or brown but can be multicolor, blue, black or colorless. When checking your own skin, it is important to remember the ABCDE’s of melanoma.

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