Category Archives: Skin Care

Vitamin D

So it turns out that UVB converts vitamin D to its active form in the skin. Completely blocking UVB with sunscreen, then, will reduce your activated vitamin D, resulting in reduced calcium absorption and weakening bones. Fortunately, most of us are not slathering on the stuff, so we probably don’t need to worry about our vitamin D levels. If you are worried, however, you can always have it tested or take a supplement. Aim for 600-800 IU of vitamin D per day.


Mineral sunscreens are often formulated into small particles to enhance the way it looks on your skin. This is understandable if you’ve ever used the zinc oxide from years ago. Some have wondered if shrinking the particle size might actually allow your body to absorb the particles. Studies, however, have confirmed the particles stay on the surface of your skin, sloughing off naturally with skin cell turnover.

Contact Dermatitis

Occasionally, chemical sunscreens (those with lengthy, difficult to pronounce active ingredients) can cause a contact dermatitis when exposed to sun on certain people. This is an itchy mess known as a photo-allergic contact dermatitis. It feels and looks like a reaction to poison ivy, but it’s limited to the sun-exposed areas. Some of the chemical sunscreens are more prone to inducing this reaction and are easily avoided with a quick perusal at the active ingredients or using mineral sunscreens.

If you choose to wear sunscreen, it’s especially helpful when used prior to exposure to ultraviolet light at its highest intensity (between 10 AM and 2 PM).  If your goal is to prevent photo-aging, we usually recommend applying a broad-spectrum sunscreen every morning before leaving the house.  And again, it’s important to apply more sunscreen when sweat or water is rubbing it off.

Anyone who finds themself on the following list would likely benefit from wearing sunscreen:

  • Those who sunburn (the faster it takes to burn, the more the benefit)
  • Those who work outdoors
  • Those who would like to maintain youthful skin, free of wrinkles and uneven pigment
  • Those who would like to avoid developing a skin cancer (or a subsequent skin cancer)
  • Those who take certain medicines that make them burn easier in the sun
  • Those with certain auto-immune conditions, such as lupus

Everyone has heard of SPF, or sun protection factor.  It’s been around for years and is formulated into number of products, but mostly into sunscreens.  Simply, SPF is a measure of what higher dose of ultraviolet B you can tolerate before you burn once applied.  There are three important points here.  First, it only works if you apply it.  That is, it does not protect you if it stays in the bottle.  Second, it only works if you apply it correctly.  The teaspoon rule may be helpful for some—1 teaspoon on the face, head, and neck, 1 teaspoon on each arm, 2 teaspoons on the trunk, and 2 teaspoons on each leg.  Furthermore, you may need to reapply if you are in the sun for a long time, sweating it off, or swimming it off.  Water resistant sunscreens may help in the latter two scenarios. Third, it only works for UVB.  For this reason, we now have UVA (or broad-spectrum) sunscreens

Let’s start with the sun. As you may be aware, it emits visible light (which helps us see) and infrared radiation (which warms our bodies and planet). It also emits ultraviolet radiation in three forms, conveniently named ultraviolet A (UVA), ultraviolet B (UVB), and ultraviolet C (UVC). Thanks to our atmosphere blocking virtually all of the UVC, most of us need only be concerned with the first two, namely UVA and UVB.

Interestingly, our skin does a great job at shielding our insides from the sun’s harmful rays. If our skin weren’t there, we would all be developing internal cancers at a young age (we would also look grotesque).

Great, so skin protects us. In so doing, however, it unfortunately acquires some damage. The sun’s UVB penetrates into the outermost layers of the skin, while its’ UVA penetrates into the deeper layers. The pigment in our skin cells (called melanin) helps absorb and reflect some of the rays. With higher, sustained doses of ultraviolet light, our skin cells enhance the production of melanin, but at a certain point, they cannot keep up.

So, then what happens? Most importantly, the DNA in our skin cells reluctantly absorbs the radiation. This event is thought to be the main reason we make skin cancers, including basal cell carcinoma, squamous cell carcinoma, and melanoma.
Secondly, the radiation creates chemicals called free radicals, which eventually erodes the support structure in our skin. This results in wrinkled, less elastic skin, making us look older than we should.

One of the most common reasons people visit a Dermatologist is for a Full Body Skin Examination, or a “Skin Check.”. A skin check is a chance for the dermatologist to assess your risk factors for developing skin cancer; address any lesions that might concern you; and examine your entire skin, from head to toe, to look for any concerning growths.

Skin cancer is the most common form of cancer in the United States; more than 3.5 million skin cancers are diagnosed yearly in this country. Basal Cell Carcinoma and Squamous Cell Carcinoma are more common types of skin cancer and are referred to as “non-melanoma skin cancer.” They do not tend to spread to the rest of the body, but they can be disfiguring if left to grow for many years. Melanoma is less common, but more dangerous in that it does tend to spread to the rest of the body and can cause death. Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.

What are the risk factors for skin cancer?

There are several risk factors for skin cancer. People with lighter pigmented skin are at higher risk, but having darker skin does not exclude you- case in point is Bob Marley, a Jamaican musician, who developed Melanoma on his toe. People with red hair are also at higher risk. A history of sunburns is especially concerning- a person’s risk for melanoma doubles if he or she has had more than five sunburns; and blistering sunburns increase the risk even further. Family history of skin cancer can also increase your risk. It is important to find out which type of skin cancer (melanoma or non-melanoma) as melanoma tends to be passed in families. Those with outdoor occupations and hobbies like construction workers, farmers, and golfers are also at high risk.
Tanning bed use is also important. One tanning bed session increases users’ risk of developing squamous cell carcinoma by 67 percent and basal cell carcinoma by 29 percent. Also, just one session increases a patient’s chances of developing melanoma by 20 percent, and each additional session during the same year boosts the risk almost another two percent.Of melanoma cases among 18-to-29-year-olds who had tanned indoors, 76 percent were attributable to tanning bed use.

What can you expect during a skin check?

Your provider will assess your risk factors for skin cancer by asking about your family history, your occupation, amount of tanning bed exposure, number of sunburns in your life, and amount of sun protection you use. You will most likely be asked to get into a gown (although some men prefer to simply remove their shirt). Your provider will also ask you if there are any specific lesions that concern you and focus on these first then he will examine your skin in a specific order- I usually go head to toe, but some providers may have another order that they prefer. It is best to let the provider do the check in order so that they don’t skip an area.

Some providers may use a special light, called a dermatoscope, to look at your moles more closely- this allows us to look a little deeper into the skin to see how the pigment is arranged and if there are any blood vessels in the lesion. However, don’t be alarmed if they do not use a special light- some moles need examination with one, but most do not.

It is best to come with no make-up on, so we can adequately examine the skin on your face. You may ask the nurse for face wash if you are coming straight from work or an outing and need to remove your make-up. It is also a good idea to take your socks off, since there is a type of Melanoma that grows specifically on the toes.

If your provider finds a suspicious lesion, she may circle it and plan for a biopsy. A biopsy involves numbing the lesion and taking a small sample. If the lesion comes back a skin cancer, there may be more that they have to do. Some lesions, like precancerous lesions, are amenable to freezing, and your provider may perform that procedure during your check as well.

What can you do at home?

Most importantly, your provider will discuss sun protection with you during your skin check. I recommend SPF 30 or higher sunscreen with “Broad Spectrum” written on the label; reapplication every two hours when outdoors is important. Broad-brimmed hats with no holes cover the ears, whereas baseball caps do not (the ears are a common place for skin cancer). A white T-shirt only gives you an SPF of 3, so if you spend a lot of time in the sun, consider investing in some clothes that contain SPF; companies like Coolibar and Bass Pro Shop sell all sorts of clothing items with sun protection within them. Also seek shade and avoid the outdoors between10AM and 4PM.

Monthly self-skin examinations (with a significant other if available) are also an important key to early detection. Married people with a diagnosis of melanoma have significantly lower death rates than singletons, most likely because a spouse is likely to detect a changing mole earlier. It is important to look everywhere! In women the most common place to get melanoma is the backs of the legs and in men it is the back. It is helpful for you and your spouse to have a good picture of what your moles look like at baseline so that when something changes you can come see us quickly.

Do you need a skin check?

If you have any concerning moles or growths, have any of the risk factors described above, have a family or personal history of skin cancer, or just want someone to look in the places you can’t see, you probably should give us a call for a full body skin examination. We look forward to seeing you soon!

-Carley Fowler, MD

** All statistics are from the Skin Cancer Foundation web site

Do you have stubborn brown spots, sun damaged skin or redness? Want to do something about it, but don’t want to have to come back for multiple treatments and not have to worry about a lot of downtime? If you answered yes to any of these questions then you could be a great candidate for the IPL/PDT treatment!

Intense Pulsed Light with Photodynamic Therapy is the popular “photodynamic photorejuvenation” technique which can decrease the number of required sessions for a predictably dramatic improvement in the aging and sun damaged patient.  Most patients get excellent results with just one treatment.  You can maintain these results if you continue to apply sunscreen daily and not abuse the sun.  No coming back for multiple treatments! One and done! Be prepared to be here for about 3 hours, and it usually takes 5-10 days to heal. Peeling and redness is expected.

Pamper Yourself

If you are looking for something with no downtime and a little bit more relaxing, schedule a facial. Mention this blog and get 50% off the service. After the facial we can discuss other treatment options and skin care maintenance to keep your skin looking young and vibrant!

Lynzie Douglass, Licensed Esthetician

As a dermatologist, what is the inevitable question that I get asked at every family gathering, girls night out or social function: “So what should I be doing to take care of my skin?”  I understand why women and men ask that question. If I had free access to physicians in other fields, I would be asking them the many questions that I have too.  So, truly, I understand.  I also realize that we as consumers are bombarded with advertisements for the latest, greatest wrinkle removing cream, chemical peel or laser treatment that are “guaranteed to work!”  It is hard to know what to believe and what really is too good to be true.  I also know that when you actually go to the store to buy a product it can be quite overwhelming.  There are hundreds of different cleansers, moisturizers, toners, and serums.  And let’s face it, none of this stuff is cheap.  So that takes me back to the popular question, “So what should I be doing to take care of my skin?” Continued ›