Musings of a NYC Dermatologist

Earlier in her career, Dr. Dina Strachan wrote a series of blogs under the title of Musings of a NYC Dermatologist between May 4, 2011, and July 14, 2017. These short posts were a unique collection of her thoughts, perspectives, and expertise on a variety of topics related to health and the medical community.

We have gone through the archives and assembled a "best of" collection of these posts on topics that are still relevant today. Please enjoy and be educated from the perspective of a board-certified dermatologist and her many years of training and experience.


Stay Out of the Tanning Bed Please!

According to a survey recently released by the American Academy of Dermatology, the majority of white females aged 14-22 years old surveyed, 81%, report tanning or using tanning beds in the past year.  Sun tanning or using artificial tanning beds are documented sources of ultraviolet light, a know cause of skin cancer, including the deadliest form- malignant melanoma.  In fact, melanoma is the most common cancer diagnosed in young adults 25-29 years old.  Rates in women under 40 years old have been rising since the early 1990s and melanoma is the second most common cause of cancer death in women under 40 years old.

May is Melanoma Awareness Month.  In honor of that fact, I will be doing a number of blog posts on prevention and identification of this condition.  Watch the You Tube video in which I discuss why tanning bed use increases one’s risk of developing  life-threatening melanoma:

Dr. Strachan Comments About Health Care Costs in the AMA News

Many people falsely think of dermatology as primarily a cash business.  Although cosmetic procedures get a lot of press, most people see the dermatologist for medical problems and if they have insurance they want to be able to use it.  Check out Dr. Strachan’s quote in this AMA news article about the increasing costs on patients who have insurance:

A Fungus Among Us

Have you been noticing discolored spots on your neck, chest, back, and arms?  This may be a sign of warmer weather, and humidity as well as a minor fungal infection tinea versicolor.

Our skin is the home of a variety of organisms including bacteria, viruses, and fungi (including yeast).  Tinea versicolor, also known as pityriasis versicolor,  is a condition caused by the overgrowth of yeast that lives on our skin.  Affected people develop pink, tan, brown, or lighter slightly scaly flat lesions most commonly on the chest, back, arms, and neck.  It tends to occur in warm humid months, particularly on people who perspire a lot.  It also occurs more commonly on people who work out, do bikram yoga, and linger in their sweaty clothes.  It may also  itch.

Tinea versicolor may be treated with topical or oral medicine.  The condition is related to dandruff and can sometimes respond to washing the area with dandruff shampoo. The discoloration tends to persist for some time after the infection has cleared (there should be no scale if the infection is gone).  Tinea versicolor tends to recur because the fungus is always there.  It is when the conditions are right, when the skin is warm and moist, it overgrows.

Five Things you may not know about Basal Cell Carcinoma (BCC)

Five things you may not know about basal cell carcinoma (BCC)

  1. Basal cell carcinoma is the most common skin cancer
  2. Basal cell carcinoma is less likely to spread than other cancers, but it should still be treated.
  3. Basal cell carcinomas may look different on people with dark skin.  More commonly found on people with light skin, BCCs are typically pink, pearly papules.  In people with dark skin, the lesions tend to be pigmented, looking more like a mole.
  4. BCCs are associated with cumulative sun damage over a lifetime.  So even if you had a lot of exposure in the past, it is still worth it to protect the skin.
  5. Although surgical treatment is the standard, sometimes a cream can be used to treat BCC.

What is the Relationship Between Dark Marks, Scars and Acne?

Many patients come seeking help regarding dark spots on their faces that they sometimes refer to as scars. They are surprised to learn that their primary problem is acne and that, technically, these marks are not scars but what we refer to as post-inflammatory hyperpigmentation.

Acne is a common skin condition that starts with a keratin plug in the hair follicle. The body can react to this plug by mounting an inflammatory response, with redness and swelling, much like it might to a splinter in the skin. In people with dark skin, or skin that tans easily, the body responds by making extra pigment leaving a dark mark. In people with lighter skin inflammation appears as redness or erythema. Although acne can cause scars, neither the dark marks, nor the red marks, made by acne are scars. True acne scars occur when the inflammation is more severe causing destruction of tissue or an abnormal healing response causing thickening of tissue. Discoloration caused by acne is generally temporary. Scars, however, are permanent, although they improve over time.

Another way to distinguish discoloration caused by acne and scars caused by acne is to compare them to a tee shirt. If one were to spill wine or coffee on a white tee shirt, this would be the equivalent of post-inflammatory hyperpigmentation (dark marks) or persistent erythema (pink marks). These marks could generally be removed. If one were to tear the fabric of the tee shirt and then patch it up, this would be like an acne scar. The hole would be gone but the texture would not be the same.

Either way, the best way to treat and prevent dark marks, red marks, and scars from acne is to treat the acne.

Neglected Areas of the Sun Protected

Even people who are disciplined sun protectors miss areas when they are following the advice to use sunscreen with an SPF of 30 or higher with UVA protection. Before you head to the beach, on that hike, sailing, or just that walk down the street on a day to be spent out in the sun, pay special attention to avoid sunburns and sun damage on these areas:

  1. scalp- people who are balding, who have fine hair, or who part their hair in the middle should consider applying liquid sunscreen to the exposed areas of the scalp or wearing a hat or scarf. Sunburns, or even skin cancers such as melanoma can occur on this area.
  2. ears- Whether your ears stick out a little or a lot, they are out there, vulnerable to sun exposure. Make sure to protect them.
  3. lips- Lip balms with SPF, or opaque lipstick, may be in order if you are out in the sun
  4. neck- The neck, particularly the back of the neck, often becomes very sun damaged in the unwary
  5. upper chest- Photoaging on the chest, and increased risk of skin cancer, often make the person who has been so meticulous about facial care, look weathered.

Winter Skin Tips

Despite the balmy weather here in NYC on this last day of November,  it is still important to remind ourselves that colder weather is on its way and with it a greater risk of dry, itchy skin.

In order to understand how to keep your skin from drying out during the winter, it is important to understand how it happens.  Basically, a lipid, or oil, layer on our skin helps keep the water in our skin from evaporating.   Dry cold air outside, dry warm air inside, and hot showers or baths with strong, stripping soaps disrupt this balance resulting in dry skin.  Dry skin is the most common cause of itchy skin.  It can also result in the flaring of underlying conditions such as eczema or psoriasis.   We may want to remove all the oil when we wash dishes, to get that sqweak, but this is not the case with our skin.

How does one keep one's skin hydrated during the winter? It is simple.  Here are the tips:

1. avoid bathing or showering more than once a day and keep bath time to below 10 minutes (prevents stripping of all the oil).  If you must wash up more than once, such as after working out in the gym, focus on just rinsing off unless you are truly dirty.

2. Hot water may feel great on a cold day, however,  it strips oil from the skin.  So, cool it down or make sure you moisturize well afterward.

3. Do not lather up your whole body with soap daily (it strips away the oil)- focus the soap on the armpits, groin, and buttocks.

4. Use a rich moisturizer within 10 minutes of coming out of the shower to seal  the water in freshly hydrated skin.  Remember creams and ointments may be better than lotions in the winter if the skin is very dry.

5. Use a humidifier or place a pan of water on the radiator.

Jewelry, Jeans and Skin Allergy Testing

Most little girls of West Indian descent of my generation had their ears pierced during infancy.  My mother waited until I was older to pierce mine.  It was because I was a twin.  She was concerned that my brother would see my bright shiny earrings and pull on them.  As I waited years to be allowed to wear earrings, like all the other little girls, it was impressed on me that it was important to take care of my ears should I get them pierced.  I was warned that poor care could result in infection—and that my holes would close up.

I finally had my ears pierced when I was seven years old.  My mother, a physician, did it in the living room with a surgical needle and a potato.  I had a suture in my ear for at least a month.  Then I graduated to getting real earrings.  The starter earrings were gold.  Then I expanded to other fun earrings.  I took care of my piercings, cleaning them regularly with alcohol, but I always had problems.  My ears would get itchy and red.  They would crust.  I’d put antibiotic ointment on them—it didn’t help.  Eventually, I had to take the earrings out.  My ears would close up and I’d feel ashamed that I wasn’t mature enough to take care of earring piercings.  By the time I was in high school, I had had my ears pierced three times.  It was years before I figured out that my problem was not poor habits resulting in an infection.

Eventually, I realized that the problem wasn’t me but the earrings I was wearing.  I would get a reaction to some earrings and not others.  I was relieved to finally figure out that I was allergic to nickel in some earrings.  Avoiding this metal allowed me to enjoy wearing earrings without a reaction.  There were even “fun” earrings made with surgical steel for nickel-allergic people like me.

Now, nickel allergy in jewelry is a well-known cause of contact dermatitis—particularly in North American women.  Some causes of nickel allergy, however, are not as well known.  Now that I am a dermatologist, I more commonly see people coming in with a recurrent itchy, rash on the abdomen that they cannot explain.  This, too, is a nickel allergy—usually to a belt buckle or the metal studs on the buttons of jeans.

Sometimes it’s obvious that someone likely has a nickel allergy, but types of skin allergy testing, called patch testing can help more directly identify what may be causing a recurrent rash.  Patch testing usually requires 3 visits in 1 week.  The first is to place the test patches and the 2nd and 3rd are to read the results.  If you think that you might be having a reaction to something your skin is coming into contact with, make an appointment to be considered for patch testing today.

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