Lily Talakoub, MD

 

The rise of noninvasive procedures has shifted the aesthetic culture. Patients now are asking for less invasive, less painful, less expensive procedures with short recovery times. Thread-lifts are one of the newest approaches to nonsurgical facial tightening. However, are they of value? Where, and for whom?

Conceptually, the thread-lift is the suspension of ptotic facial soft tissue via a thread subcutaneously inserted in the skin. It is an easy, fast, in-office procedure in which a cone attachment or barbed or nonbarbed suture thread is inserted via a cannula into the skin through a very small incision. The thread is essentially “hooked” to the skin and, with a minimal amount of tightening, the skin is lifted and the suture is cut at the insertion point. The sutures dissolve and, over time, produce scar tissue.

The thread-lifts initially came onto the market in the late 1990s but were difficult to use. The nonabsorbable threads had to be anchored into the scalp, temple, and brow region. The anchoring knots were carefully tied and were permanent. The newest technology threads – NovaThreads and the Silhouette Instalift – have recently received Food and Drug Administration clearance and grown in popularity because of their “lunchtime” appeal and their ease of use. Primarily marketed for the neck, jowls, and lower face, these threads – available in various sizes, lengths, and diameters – can be used almost anywhere. The sutures dissolve over time and do not need any anchoring, making it a very simple in-office procedure.

Side effects include mild procedural pain, edema, erythema, bruising, and rarely, suture granuloma formation; and they may need to be replaced. If not done properly, buckling of the skin can occur and superficially placed sutures can be visible.

Similar to fillers that provide a “liquid face-lift,” the down time is minimal. Common side effects include bruising, and patients should refrain from heavy exercise and opening their mouth wide with chewing for 5-7 days (such as eating a large apple). Soreness, particularly in or near the hairline or jaw line, can occur and can last up to 2 weeks. Dimpling in the skin can occur and usually resolves on its own; however, if threads are placed incorrectly, dimpling can cause some disfigurement.

Results can vary based on the tissue laxity, and the type, amount, and location of the threads used. While results have been reported to last 18 months to 2 years, the procedure is not a replacement for fillers. Facial aging is caused by a combination of skeletal, soft tissue, and skin changes that lead to soft tissue laxity and volume loss. Fillers are essential in restoring lost volume in the aging face and are particularly helpful in combination with tissue tightening lasers, face-lifts and the thread-lift procedures. Fillers used in combination with thread-lifts also increase the longevity of the thread-lift because of additional collagen stimulation.

As the procedure is not indicated for severe laxity, thread-lifts also do not replace the traditional face-lift. Tissue is not released from its underlying attachments, and skin contraction and gravitational pull limit its extent of improvement and its longevity.

Long-term success of the thread-lift procedure for facial rejuvenation was evaluated in a retrospective review of 33 patients who underwent the traditional thread-lift procedure alone or in combination with other facial rejuvenation procedures to the brow, mid-face, jowl, and neck published in 2009.¹ The study compared results in 10 patients who had a thread-lift alone, 23 who had thread-lifts combined with other procedures, and controls, who were 10 ten patients who had non–thread-lift rejuvenation procedures, which included lipotransfer, chemical peels, and rhytidectomies. Independent, blinded, board-certified facial plastic surgeons evaluated pre- and postoperative photos. Patients were followed-up for a mean of 21 months.

At 1 month, aesthetic improvements were observed in all treatment groups. Measurable results through the end of the study period were seen in all the patient groups, with the exception of the group of patients who had the thread-lift procedure alone. Aesthetic improvements observed in the control group were significantly better than were the improvements in the thread-lift only group. In addition, aesthetic improvement scores among those who had the thread-lift plus other procedures were significantly better than were the scores among those who had the thread-lift only. The authors concluded that the thread-lift procedure resulted in only short-term improvements, because of the edema and inflammation related to the procedure. They also concluded that thread-lifts were not effective because they did not produce any volumetric change and only superficially repositioned the soft tissues without addressing excess skin.

While thread-lifts are a beneficial addition to our armamentarium of noninvasive aesthetic procedures, they have better outcomes and higher patient satisfaction when used in combination with fillers, radiofrequency, and fractional lasers and neuromodulators.

Reference

1. Abraham RF et al. Arch Facial Plast Surg. 2009 May-Jun;11(3):178-83.
 

Dr. Talakoub and Dr. Wesley are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

 

The rise of noninvasive procedures has shifted the aesthetic culture. Patients now are asking for less invasive, less painful, less expensive procedures with short recovery times. Thread-lifts are one of the newest approaches to nonsurgical facial tightening. However, are they of value? Where, and for whom?

Conceptually, the thread-lift is the suspension of ptotic facial soft tissue via a thread subcutaneously inserted in the skin. It is an easy, fast, in-office procedure in which a cone attachment or barbed or nonbarbed suture thread is inserted via a cannula into the skin through a very small incision. The thread is essentially “hooked” to the skin and, with a minimal amount of tightening, the skin is lifted and the suture is cut at the insertion point. The sutures dissolve and, over time, produce scar tissue.

The thread-lifts initially came onto the market in the late 1990s but were difficult to use. The nonabsorbable threads had to be anchored into the scalp, temple, and brow region. The anchoring knots were carefully tied and were permanent. The newest technology threads – NovaThreads and the Silhouette Instalift – have recently received Food and Drug Administration clearance and grown in popularity because of their “lunchtime” appeal and their ease of use. Primarily marketed for the neck, jowls, and lower face, these threads – available in various sizes, lengths, and diameters – can be used almost anywhere. The sutures dissolve over time and do not need any anchoring, making it a very simple in-office procedure.

Side effects include mild procedural pain, edema, erythema, bruising, and rarely, suture granuloma formation; and they may need to be replaced. If not done properly, buckling of the skin can occur and superficially placed sutures can be visible.

Similar to fillers that provide a “liquid face-lift,” the down time is minimal. Common side effects include bruising, and patients should refrain from heavy exercise and opening their mouth wide with chewing for 5-7 days (such as eating a large apple). Soreness, particularly in or near the hairline or jaw line, can occur and can last up to 2 weeks. Dimpling in the skin can occur and usually resolves on its own; however, if threads are placed incorrectly, dimpling can cause some disfigurement.

Results can vary based on the tissue laxity, and the type, amount, and location of the threads used. While results have been reported to last 18 months to 2 years, the procedure is not a replacement for fillers. Facial aging is caused by a combination of skeletal, soft tissue, and skin changes that lead to soft tissue laxity and volume loss. Fillers are essential in restoring lost volume in the aging face and are particularly helpful in combination with tissue tightening lasers, face-lifts and the thread-lift procedures. Fillers used in combination with thread-lifts also increase the longevity of the thread-lift because of additional collagen stimulation.

As the procedure is not indicated for severe laxity, thread-lifts also do not replace the traditional face-lift. Tissue is not released from its underlying attachments, and skin contraction and gravitational pull limit its extent of improvement and its longevity.

Long-term success of the thread-lift procedure for facial rejuvenation was evaluated in a retrospective review of 33 patients who underwent the traditional thread-lift procedure alone or in combination with other facial rejuvenation procedures to the brow, mid-face, jowl, and neck published in 2009.¹ The study compared results in 10 patients who had a thread-lift alone, 23 who had thread-lifts combined with other procedures, and controls, who were 10 ten patients who had non–thread-lift rejuvenation procedures, which included lipotransfer, chemical peels, and rhytidectomies. Independent, blinded, board-certified facial plastic surgeons evaluated pre- and postoperative photos. Patients were followed-up for a mean of 21 months.

At 1 month, aesthetic improvements were observed in all treatment groups. Measurable results through the end of the study period were seen in all the patient groups, with the exception of the group of patients who had the thread-lift procedure alone. Aesthetic improvements observed in the control group were significantly better than were the improvements in the thread-lift only group. In addition, aesthetic improvement scores among those who had the thread-lift plus other procedures were significantly better than were the scores among those who had the thread-lift only. The authors concluded that the thread-lift procedure resulted in only short-term improvements, because of the edema and inflammation related to the procedure. They also concluded that thread-lifts were not effective because they did not produce any volumetric change and only superficially repositioned the soft tissues without addressing excess skin.

While thread-lifts are a beneficial addition to our armamentarium of noninvasive aesthetic procedures, they have better outcomes and higher patient satisfaction when used in combination with fillers, radiofrequency, and fractional lasers and neuromodulators.

Reference

1. Abraham RF et al. Arch Facial Plast Surg. 2009 May-Jun;11(3):178-83.
 

Dr. Talakoub and Dr. Wesley are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

 

The rise of noninvasive procedures has shifted the aesthetic culture. Patients now are asking for less invasive, less painful, less expensive procedures with short recovery times. Thread-lifts are one of the newest approaches to nonsurgical facial tightening. However, are they of value? Where, and for whom?

Conceptually, the thread-lift is the suspension of ptotic facial soft tissue via a thread subcutaneously inserted in the skin. It is an easy, fast, in-office procedure in which a cone attachment or barbed or nonbarbed suture thread is inserted via a cannula into the skin through a very small incision. The thread is essentially “hooked” to the skin and, with a minimal amount of tightening, the skin is lifted and the suture is cut at the insertion point. The sutures dissolve and, over time, produce scar tissue.

The thread-lifts initially came onto the market in the late 1990s but were difficult to use. The nonabsorbable threads had to be anchored into the scalp, temple, and brow region. The anchoring knots were carefully tied and were permanent. The newest technology threads – NovaThreads and the Silhouette Instalift – have recently received Food and Drug Administration clearance and grown in popularity because of their “lunchtime” appeal and their ease of use. Primarily marketed for the neck, jowls, and lower face, these threads – available in various sizes, lengths, and diameters – can be used almost anywhere. The sutures dissolve over time and do not need any anchoring, making it a very simple in-office procedure.

Side effects include mild procedural pain, edema, erythema, bruising, and rarely, suture granuloma formation; and they may need to be replaced. If not done properly, buckling of the skin can occur and superficially placed sutures can be visible.

Similar to fillers that provide a “liquid face-lift,” the down time is minimal. Common side effects include bruising, and patients should refrain from heavy exercise and opening their mouth wide with chewing for 5-7 days (such as eating a large apple). Soreness, particularly in or near the hairline or jaw line, can occur and can last up to 2 weeks. Dimpling in the skin can occur and usually resolves on its own; however, if threads are placed incorrectly, dimpling can cause some disfigurement.

Results can vary based on the tissue laxity, and the type, amount, and location of the threads used. While results have been reported to last 18 months to 2 years, the procedure is not a replacement for fillers. Facial aging is caused by a combination of skeletal, soft tissue, and skin changes that lead to soft tissue laxity and volume loss. Fillers are essential in restoring lost volume in the aging face and are particularly helpful in combination with tissue tightening lasers, face-lifts and the thread-lift procedures. Fillers used in combination with thread-lifts also increase the longevity of the thread-lift because of additional collagen stimulation.

As the procedure is not indicated for severe laxity, thread-lifts also do not replace the traditional face-lift. Tissue is not released from its underlying attachments, and skin contraction and gravitational pull limit its extent of improvement and its longevity.

Long-term success of the thread-lift procedure for facial rejuvenation was evaluated in a retrospective review of 33 patients who underwent the traditional thread-lift procedure alone or in combination with other facial rejuvenation procedures to the brow, mid-face, jowl, and neck published in 2009.¹ The study compared results in 10 patients who had a thread-lift alone, 23 who had thread-lifts combined with other procedures, and controls, who were 10 ten patients who had non–thread-lift rejuvenation procedures, which included lipotransfer, chemical peels, and rhytidectomies. Independent, blinded, board-certified facial plastic surgeons evaluated pre- and postoperative photos. Patients were followed-up for a mean of 21 months.

At 1 month, aesthetic improvements were observed in all treatment groups. Measurable results through the end of the study period were seen in all the patient groups, with the exception of the group of patients who had the thread-lift procedure alone. Aesthetic improvements observed in the control group were significantly better than were the improvements in the thread-lift only group. In addition, aesthetic improvement scores among those who had the thread-lift plus other procedures were significantly better than were the scores among those who had the thread-lift only. The authors concluded that the thread-lift procedure resulted in only short-term improvements, because of the edema and inflammation related to the procedure. They also concluded that thread-lifts were not effective because they did not produce any volumetric change and only superficially repositioned the soft tissues without addressing excess skin.

While thread-lifts are a beneficial addition to our armamentarium of noninvasive aesthetic procedures, they have better outcomes and higher patient satisfaction when used in combination with fillers, radiofrequency, and fractional lasers and neuromodulators.

Reference

1. Abraham RF et al. Arch Facial Plast Surg. 2009 May-Jun;11(3):178-83.
 

Dr. Talakoub and Dr. Wesley are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

 

I admit it ... I am a victim too. The hype was real. Offer a service, at a hefty discount, and increase your patient volume. I didn’t need to increase my patient load. But with more overhead, getting the new providers in my practice busy fast was alluring. There are, however, so many inherent risks to discounting. So I offer you this column as my own version of a consumer alert on discount coupon sites.

Getty Images/Thinkstock

Cosmetic procedures are being done by everyone and anyone nowadays. Injectables, lasers, resurfacing, you name it; they can be done by nurses, physician assistants, non–board certified doctors of all specialties, and even dentists. And online discount sites offer a platform for marketing.

After falling victim to this fad myself, I realize that it was the worst business decision I have ever made – from the perspectives of the risks to the patient and the risks to the business.

The risks to the patient are transparent. The most obvious risk is the abundance of inexperienced injectors doing procedures. Self explanatory. Discount sites obtain medical license information prior to approving any medical treatment; however, not everyone with a medical license should be doing cosmetic procedures.

The second risk is a lack of proper evaluation and management, which leads to poor medical management and dissatisfaction. We should be approaching each cosmetic patient with treatments and procedures that are right for them, their skin, their medical history, their anatomy, and their specific needs. There is no screening through these sites. Patients buy the service, and even if the procedure is not right for them, they expect the service. Even if there is a statement on a site that services are contingent on screening, the promise of the service has already been made. If you do not provide the service, often the now-disgruntled patient will complain about you, your staff, your ethics, to anyone and everyone. If you do the procedure despite your best intentions, you are setting yourself up for disaster ... complications, unsatisfied patients, and unmet expectations. There is a reason consultations are necessary.

Third, the margins on this type of service are negligible. If a practice if offering injectable treatments at a too-good-to-be-true price, it probably is. Neurotoxins might be diluted, fillers could be mixed, products may be purchased from substandard overseas manufacturers, and subpar treatments and bad results can happen.

The risks to the practice, while not as transparent, are often delayed and everlasting.

First, there are the legal implications of fee-splitting in some states, such as New York and California. The laws are set up to avoid conflicts of interest and kickbacks among health care organizations. An organization cannot be paid for referring a patient to a medical practice. Second, a customer who is willing to buy a discounted cosmetic procedure offers a reason enough not to do that treatment. Many online bargain shoppers are dissatisfied customers or patients that you do not want do a cosmetic procedure on in the first place. Finally, the cost of acquiring new patients through marketing is daunting for small businesses and what these discounters offer are “free” marketing tools. Through geolocation and search engine optimization, they increase brand visibility and deliver a steady influx of customers. However, very few of the massive surge of these initial clients become return customers and, given the hefty discount and processing fees involved, the business model may not prove to be worthwhile.

This approach fosters disloyalty. If a customer can’t buy more than one deal, he or she will more than likely go elsewhere. If you are delivering substandard care, you are posing a risk to your own reputation, and those unsatisfied customers may be more likely to post negative reviews, dismantling the integrity of your practice. A study described in a 2011 article in MIT Technology Review looked at how businesses that did discount deals fared on Yelp. The study showed that, although the number of reviews increased significantly after the deal, the average rating scores from reviewers on Yelp were about 10% lower than others’ reviews. For a small business, this can be debilitating and could lead to the demise of the brand.

Everyone loves a deal, myself included. However, for your practice, there are health and ethical issues with these discount businesses. Good treatments aren’t cheap, and cheap treatments aren’t good.
 

Dr. Talakoub and Dr. Wesley are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

 

References

Sisler J. Discount deals becoming medical rage. CMAJ. 2012 Feb 21;184(3):E167-8.

Krieger LM. Discount cosmetic surgery: industry trends and strategies for success. Plast Reconstr Surg. 2002 Aug;110(2):614-9.

Atiyeh BS et al. Aesthetic/Cosmetic surgery and ethical challenges. Aesthetic Plast Surg. 2008 Nov;32(6):829-39.

Groupon’s Hidden Influence on Reputation. MIT Technology Review. Sept. 12, 2011.

 

I admit it ... I am a victim too. The hype was real. Offer a service, at a hefty discount, and increase your patient volume. I didn’t need to increase my patient load. But with more overhead, getting the new providers in my practice busy fast was alluring. There are, however, so many inherent risks to discounting. So I offer you this column as my own version of a consumer alert on discount coupon sites.

Getty Images/Thinkstock

Cosmetic procedures are being done by everyone and anyone nowadays. Injectables, lasers, resurfacing, you name it; they can be done by nurses, physician assistants, non–board certified doctors of all specialties, and even dentists. And online discount sites offer a platform for marketing.

After falling victim to this fad myself, I realize that it was the worst business decision I have ever made – from the perspectives of the risks to the patient and the risks to the business.

The risks to the patient are transparent. The most obvious risk is the abundance of inexperienced injectors doing procedures. Self explanatory. Discount sites obtain medical license information prior to approving any medical treatment; however, not everyone with a medical license should be doing cosmetic procedures.

The second risk is a lack of proper evaluation and management, which leads to poor medical management and dissatisfaction. We should be approaching each cosmetic patient with treatments and procedures that are right for them, their skin, their medical history, their anatomy, and their specific needs. There is no screening through these sites. Patients buy the service, and even if the procedure is not right for them, they expect the service. Even if there is a statement on a site that services are contingent on screening, the promise of the service has already been made. If you do not provide the service, often the now-disgruntled patient will complain about you, your staff, your ethics, to anyone and everyone. If you do the procedure despite your best intentions, you are setting yourself up for disaster ... complications, unsatisfied patients, and unmet expectations. There is a reason consultations are necessary.

Third, the margins on this type of service are negligible. If a practice if offering injectable treatments at a too-good-to-be-true price, it probably is. Neurotoxins might be diluted, fillers could be mixed, products may be purchased from substandard overseas manufacturers, and subpar treatments and bad results can happen.

The risks to the practice, while not as transparent, are often delayed and everlasting.

First, there are the legal implications of fee-splitting in some states, such as New York and California. The laws are set up to avoid conflicts of interest and kickbacks among health care organizations. An organization cannot be paid for referring a patient to a medical practice. Second, a customer who is willing to buy a discounted cosmetic procedure offers a reason enough not to do that treatment. Many online bargain shoppers are dissatisfied customers or patients that you do not want do a cosmetic procedure on in the first place. Finally, the cost of acquiring new patients through marketing is daunting for small businesses and what these discounters offer are “free” marketing tools. Through geolocation and search engine optimization, they increase brand visibility and deliver a steady influx of customers. However, very few of the massive surge of these initial clients become return customers and, given the hefty discount and processing fees involved, the business model may not prove to be worthwhile.

This approach fosters disloyalty. If a customer can’t buy more than one deal, he or she will more than likely go elsewhere. If you are delivering substandard care, you are posing a risk to your own reputation, and those unsatisfied customers may be more likely to post negative reviews, dismantling the integrity of your practice. A study described in a 2011 article in MIT Technology Review looked at how businesses that did discount deals fared on Yelp. The study showed that, although the number of reviews increased significantly after the deal, the average rating scores from reviewers on Yelp were about 10% lower than others’ reviews. For a small business, this can be debilitating and could lead to the demise of the brand.

Everyone loves a deal, myself included. However, for your practice, there are health and ethical issues with these discount businesses. Good treatments aren’t cheap, and cheap treatments aren’t good.
 

Dr. Talakoub and Dr. Wesley are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

 

References

Sisler J. Discount deals becoming medical rage. CMAJ. 2012 Feb 21;184(3):E167-8.

Krieger LM. Discount cosmetic surgery: industry trends and strategies for success. Plast Reconstr Surg. 2002 Aug;110(2):614-9.

Atiyeh BS et al. Aesthetic/Cosmetic surgery and ethical challenges. Aesthetic Plast Surg. 2008 Nov;32(6):829-39.

Groupon’s Hidden Influence on Reputation. MIT Technology Review. Sept. 12, 2011.

 

I admit it ... I am a victim too. The hype was real. Offer a service, at a hefty discount, and increase your patient volume. I didn’t need to increase my patient load. But with more overhead, getting the new providers in my practice busy fast was alluring. There are, however, so many inherent risks to discounting. So I offer you this column as my own version of a consumer alert on discount coupon sites.

Getty Images/Thinkstock

Cosmetic procedures are being done by everyone and anyone nowadays. Injectables, lasers, resurfacing, you name it; they can be done by nurses, physician assistants, non–board certified doctors of all specialties, and even dentists. And online discount sites offer a platform for marketing.

After falling victim to this fad myself, I realize that it was the worst business decision I have ever made – from the perspectives of the risks to the patient and the risks to the business.

The risks to the patient are transparent. The most obvious risk is the abundance of inexperienced injectors doing procedures. Self explanatory. Discount sites obtain medical license information prior to approving any medical treatment; however, not everyone with a medical license should be doing cosmetic procedures.

The second risk is a lack of proper evaluation and management, which leads to poor medical management and dissatisfaction. We should be approaching each cosmetic patient with treatments and procedures that are right for them, their skin, their medical history, their anatomy, and their specific needs. There is no screening through these sites. Patients buy the service, and even if the procedure is not right for them, they expect the service. Even if there is a statement on a site that services are contingent on screening, the promise of the service has already been made. If you do not provide the service, often the now-disgruntled patient will complain about you, your staff, your ethics, to anyone and everyone. If you do the procedure despite your best intentions, you are setting yourself up for disaster ... complications, unsatisfied patients, and unmet expectations. There is a reason consultations are necessary.

Third, the margins on this type of service are negligible. If a practice if offering injectable treatments at a too-good-to-be-true price, it probably is. Neurotoxins might be diluted, fillers could be mixed, products may be purchased from substandard overseas manufacturers, and subpar treatments and bad results can happen.

The risks to the practice, while not as transparent, are often delayed and everlasting.

First, there are the legal implications of fee-splitting in some states, such as New York and California. The laws are set up to avoid conflicts of interest and kickbacks among health care organizations. An organization cannot be paid for referring a patient to a medical practice. Second, a customer who is willing to buy a discounted cosmetic procedure offers a reason enough not to do that treatment. Many online bargain shoppers are dissatisfied customers or patients that you do not want do a cosmetic procedure on in the first place. Finally, the cost of acquiring new patients through marketing is daunting for small businesses and what these discounters offer are “free” marketing tools. Through geolocation and search engine optimization, they increase brand visibility and deliver a steady influx of customers. However, very few of the massive surge of these initial clients become return customers and, given the hefty discount and processing fees involved, the business model may not prove to be worthwhile.

This approach fosters disloyalty. If a customer can’t buy more than one deal, he or she will more than likely go elsewhere. If you are delivering substandard care, you are posing a risk to your own reputation, and those unsatisfied customers may be more likely to post negative reviews, dismantling the integrity of your practice. A study described in a 2011 article in MIT Technology Review looked at how businesses that did discount deals fared on Yelp. The study showed that, although the number of reviews increased significantly after the deal, the average rating scores from reviewers on Yelp were about 10% lower than others’ reviews. For a small business, this can be debilitating and could lead to the demise of the brand.

Everyone loves a deal, myself included. However, for your practice, there are health and ethical issues with these discount businesses. Good treatments aren’t cheap, and cheap treatments aren’t good.
 

Dr. Talakoub and Dr. Wesley are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

 

References

Sisler J. Discount deals becoming medical rage. CMAJ. 2012 Feb 21;184(3):E167-8.

Krieger LM. Discount cosmetic surgery: industry trends and strategies for success. Plast Reconstr Surg. 2002 Aug;110(2):614-9.

Atiyeh BS et al. Aesthetic/Cosmetic surgery and ethical challenges. Aesthetic Plast Surg. 2008 Nov;32(6):829-39.

Groupon’s Hidden Influence on Reputation. MIT Technology Review. Sept. 12, 2011.

As a follow-up to our previous column on the effects of climate change on the skin (Dermatology News, June 2016, p. 28), this month’s column will focus on a study recently published in Clinical Infectious Diseases that explores warmer weather as a possible risk factor for cellulitis.¹ As the summer continues with sweltering weather, humidity, and the recent spate of hurricanes in North America, it’s interesting to think about how the climate affects our patients and puts them at risk.

rottadana/Thinkstock

Analyzing hospital discharge data from a national inpatient health care database (the National Inpatient Sample) from 1998 to 2011 of more than 108 million hospital admissions (of which 1.3% were for cellulitis), the investigators found that the odds of a hospital admission for cellulitis increased with higher temperatures, with a dose-response pattern. Their analysis included diagnosis codes for cellulitis, abscess of the fingers and toes, and other cellulitis/abscess, and they used national climate data to estimate the average monthly temperature for different regions.

The odds of cellulitis admissions increased by roughly 3.55% for each 5° F increment in temperature. For example, the odds of being admitted to the hospital with cellulitis were 66.3% greater during a hot July with an average temperature above 90°F than during a cold February in some regions where the monthly temperature averaged below 40°F. Several comorbidities associated with infection risk were also strongly associated with a higher odds of a cellulitis admission in this study: For example, for patients with diabetes, the odds were 146% higher, and for patients labeled as obese, the odds were 122% higher.

Since bacteria and fungi – especially gram-positive organisms, such as staphylococcus and streptococcus, that most commonly cause skin and soft-tissue infections – often thrive in warm moist environments, it’s not surprising that warmer weather is playing a role in an increased prevalence of infectious diseases during the warmer months.

Much attention has been given to global warming and climate change over the past several years. The results of this study demonstrate that, if temperatures consistently increase, the odds of cellulitis also may increase in regions exposed to warmer temperatures.
 

Dr. Wesley and Dr. Talakoub are cocontributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

Reference

1. Clin Infect Dis. 2017 Jul 31. doi: 10.1093/cid/cix487.


 

As a follow-up to our previous column on the effects of climate change on the skin (Dermatology News, June 2016, p. 28), this month’s column will focus on a study recently published in Clinical Infectious Diseases that explores warmer weather as a possible risk factor for cellulitis.¹ As the summer continues with sweltering weather, humidity, and the recent spate of hurricanes in North America, it’s interesting to think about how the climate affects our patients and puts them at risk.

rottadana/Thinkstock

Analyzing hospital discharge data from a national inpatient health care database (the National Inpatient Sample) from 1998 to 2011 of more than 108 million hospital admissions (of which 1.3% were for cellulitis), the investigators found that the odds of a hospital admission for cellulitis increased with higher temperatures, with a dose-response pattern. Their analysis included diagnosis codes for cellulitis, abscess of the fingers and toes, and other cellulitis/abscess, and they used national climate data to estimate the average monthly temperature for different regions.

The odds of cellulitis admissions increased by roughly 3.55% for each 5° F increment in temperature. For example, the odds of being admitted to the hospital with cellulitis were 66.3% greater during a hot July with an average temperature above 90°F than during a cold February in some regions where the monthly temperature averaged below 40°F. Several comorbidities associated with infection risk were also strongly associated with a higher odds of a cellulitis admission in this study: For example, for patients with diabetes, the odds were 146% higher, and for patients labeled as obese, the odds were 122% higher.

Since bacteria and fungi – especially gram-positive organisms, such as staphylococcus and streptococcus, that most commonly cause skin and soft-tissue infections – often thrive in warm moist environments, it’s not surprising that warmer weather is playing a role in an increased prevalence of infectious diseases during the warmer months.

Much attention has been given to global warming and climate change over the past several years. The results of this study demonstrate that, if temperatures consistently increase, the odds of cellulitis also may increase in regions exposed to warmer temperatures.
 

Dr. Wesley and Dr. Talakoub are cocontributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

Reference

1. Clin Infect Dis. 2017 Jul 31. doi: 10.1093/cid/cix487.


 

As a follow-up to our previous column on the effects of climate change on the skin (Dermatology News, June 2016, p. 28), this month’s column will focus on a study recently published in Clinical Infectious Diseases that explores warmer weather as a possible risk factor for cellulitis.¹ As the summer continues with sweltering weather, humidity, and the recent spate of hurricanes in North America, it’s interesting to think about how the climate affects our patients and puts them at risk.

rottadana/Thinkstock

Analyzing hospital discharge data from a national inpatient health care database (the National Inpatient Sample) from 1998 to 2011 of more than 108 million hospital admissions (of which 1.3% were for cellulitis), the investigators found that the odds of a hospital admission for cellulitis increased with higher temperatures, with a dose-response pattern. Their analysis included diagnosis codes for cellulitis, abscess of the fingers and toes, and other cellulitis/abscess, and they used national climate data to estimate the average monthly temperature for different regions.

The odds of cellulitis admissions increased by roughly 3.55% for each 5° F increment in temperature. For example, the odds of being admitted to the hospital with cellulitis were 66.3% greater during a hot July with an average temperature above 90°F than during a cold February in some regions where the monthly temperature averaged below 40°F. Several comorbidities associated with infection risk were also strongly associated with a higher odds of a cellulitis admission in this study: For example, for patients with diabetes, the odds were 146% higher, and for patients labeled as obese, the odds were 122% higher.

Since bacteria and fungi – especially gram-positive organisms, such as staphylococcus and streptococcus, that most commonly cause skin and soft-tissue infections – often thrive in warm moist environments, it’s not surprising that warmer weather is playing a role in an increased prevalence of infectious diseases during the warmer months.

Much attention has been given to global warming and climate change over the past several years. The results of this study demonstrate that, if temperatures consistently increase, the odds of cellulitis also may increase in regions exposed to warmer temperatures.
 

Dr. Wesley and Dr. Talakoub are cocontributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

Reference

1. Clin Infect Dis. 2017 Jul 31. doi: 10.1093/cid/cix487.


 

 

It may be surprising that there are dermatologic risks of UV exposure from lamps and other indoor light sources that we use daily. Is long-term daily exposure to presumably low-irradiance lights of clinical significance to photodermatoses? Recent findings suggest that skin protection must be practiced indoors to adequately protect the skin against UV rays.

Photodermatoses, such as lupus, actinic prurigo, and xeroderma pigmentosum, are only a few of the skin diseases that are triggered by UV exposure; however, chronic low-dose exposures to UV light, such as those associated with indoor lighting, may also be triggers of such conditions. Melasma, for example, can be triggered by heat or UV light. Chronic exposure to ambient light may darken the skin, necessitating daily UV protection in both indoor and outdoor settings.

level17/thinkstock

Dermatologists can attest to the number of patients that confess that they only sometimes wear sunscreen “when outside.” If UV exposure to inside lighting has more significant effects on the skin, however, more precautions must be taken to prevent skin cancer, melasma, and other skin damage from exposure through window glass, and from fluorescent bulbs, halogen lamps, and tablet and computer screens.

A study examining light sources in the environment of a child with xeroderma pigmentosum suggested that indoor lights emit unexpected amounts of UV light as measured by a spectral radiometer. This finding illustrated that cumulative, chronic doses of indoor lighting may be of clinical significance.

Interior lighting is also implicated in worsening of melasma and other photosensitive dermatoses. Incandescent bulbs have little to no UV irradiance. However, fluorescent lighting has been shown to increase lifetime UV exposure by 3% based on the distance the lamp is from the skin. If the lamp is close – particularly desk lamps, bed lamps, and overhead lamps – the light and heat emitted can worsen photoexacerbated dermatitidis. Avoiding close contact with the light or adding acrylic or plastic diffusers to the light can help reduce exposure.

Halogen bulbs are filled with an inert gas and a halogen, such as iodine. These bulbs are usually made of quartz because quartz is more resistant to the high heat emitted by these bulbs. But the quartz, however, does not block UV radiation, which is why manufacturers add UV-blocking agents and heat-resistant glass to block the UV; however, the amount blocked is usually unknown. As with fluorescent bulbs, the distance from the bulb is essential to protect against both the UV and heat emitted. Light-emitting diodes (LEDs) generate a light from a semiconductor material that converts blue light into white light with the use of phosphorus; LEDs do not emit UV rays and, therefore, are a safer light source for the skin.

Lamps that are not used for lighting also must be considered. The Food and Drug Administration recently released a consumer alert regarding the use of UV-curing lamps at nail salons because of the UV radiation emitted. Since daily use of such lamps is not common, the risk of such an exposure is low; but precautions against UV exposure have, nonetheless, been recommended. UV-protectant gloves and application of a broad spectrum sunscreen on the hands prior to use is recommended to decrease the risks of UV exposure to the hands.

In addition to the use of lamps, the light that passes through glass is easy to underestimate. Unlike UVB rays, UVA rays pass through glass and affect the skin. The percentage of UVA rays that pass through glass depends on the type of glass and the coating on the glass. There are three types of window glass: clear, reflective, and tinted. Clear glass allows 75% of UVA through,while reflective and tinted glass allow only 25%-50% of UVA rays to pass through. Low-emissivity glass (Low-E) is made to reduce heat transfer and is similar to clear glass. The most protective glass is laminated or UV-coated glass that filters out 95%-99% of all UVA rays. Unfortunately, most residential and commercial buildings do not have UVA protection. The use of blinds, shades, and tinted glass, and increasing the distance from windows and doors are the best methods of protection from chronic daily UVA exposures.

In most cars, windshield is made of laminated glass (two layers of glass with a layer of plastic in between), which blocks all UVB and approximately 50% of UVA rays. However, side and rear windows are often clear glass, which does not prevent UVA rays from penetrating through. Patients with photosensitive dermatoses and all melasma patients are encouraged to tint the side windows of their vehicles to reduce UVA exposures to 15%-30%. Tinting, however, must be in compliance with federally mandated standard of 70% minimum visible light transmittance. In my practice, daily UV protection is recommended for all patients, even within an automobile or in an office. Daily cumulative exposure can cause chronic skin damage and early signs of photoaging.

Other sources of indoor exposures include TV monitors, computers, tablets, and UV sterilization devices in the workplace. Older cathode ray tube screens emit UV radiation; however, newer liquid crystal display (LCD) or flat panel monitors most commonly on laptops, desktops, and mobile devices do not emit UV radiation. They do emit blue light – although a small fraction compared to that emitted by the sun. The amount of time spent in front of these screens and their proximity can pose a problem as blue light can increase reactive oxygen species, which is the most common contributor to premature aging. These devices also emit heat, which can exacerbate erythema ab igne and other heat-sensitive skin conditions.

Blue light has a very short wavelength with high energy. Studies have shown that permanent eye damage, including macular degeneration, from extended exposure to close-range blue light from computers and tablets is possible. Close-range blue light has been associated with increased skin melanogenesis. Skin hyperpigmentation, such as in lichen planus pigmentosus and melasma, also can be exacerbated by blue light; to prevent the worsening of such conditions, discretion is advised with regard to the use of these devices in close proximity to the skin.

The risks of indoor UV and blue light exposures are commonly overlooked. Skin protection with broad-spectrum sunscreen both inside and outside should be used daily for maximum protection. Care should also be taken to limit exposure times and increase distance of these objects from the skin and eyes.
 

 

Dr. Talakoub and Dr. Wesley are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

References

Autoimmun Rev. 2009;8(4):320-4.

Anais Brasileiros de Dermatologia. 2015;90(4):595-7.

 

It may be surprising that there are dermatologic risks of UV exposure from lamps and other indoor light sources that we use daily. Is long-term daily exposure to presumably low-irradiance lights of clinical significance to photodermatoses? Recent findings suggest that skin protection must be practiced indoors to adequately protect the skin against UV rays.

Photodermatoses, such as lupus, actinic prurigo, and xeroderma pigmentosum, are only a few of the skin diseases that are triggered by UV exposure; however, chronic low-dose exposures to UV light, such as those associated with indoor lighting, may also be triggers of such conditions. Melasma, for example, can be triggered by heat or UV light. Chronic exposure to ambient light may darken the skin, necessitating daily UV protection in both indoor and outdoor settings.

level17/thinkstock

Dermatologists can attest to the number of patients that confess that they only sometimes wear sunscreen “when outside.” If UV exposure to inside lighting has more significant effects on the skin, however, more precautions must be taken to prevent skin cancer, melasma, and other skin damage from exposure through window glass, and from fluorescent bulbs, halogen lamps, and tablet and computer screens.

A study examining light sources in the environment of a child with xeroderma pigmentosum suggested that indoor lights emit unexpected amounts of UV light as measured by a spectral radiometer. This finding illustrated that cumulative, chronic doses of indoor lighting may be of clinical significance.

Interior lighting is also implicated in worsening of melasma and other photosensitive dermatoses. Incandescent bulbs have little to no UV irradiance. However, fluorescent lighting has been shown to increase lifetime UV exposure by 3% based on the distance the lamp is from the skin. If the lamp is close – particularly desk lamps, bed lamps, and overhead lamps – the light and heat emitted can worsen photoexacerbated dermatitidis. Avoiding close contact with the light or adding acrylic or plastic diffusers to the light can help reduce exposure.

Halogen bulbs are filled with an inert gas and a halogen, such as iodine. These bulbs are usually made of quartz because quartz is more resistant to the high heat emitted by these bulbs. But the quartz, however, does not block UV radiation, which is why manufacturers add UV-blocking agents and heat-resistant glass to block the UV; however, the amount blocked is usually unknown. As with fluorescent bulbs, the distance from the bulb is essential to protect against both the UV and heat emitted. Light-emitting diodes (LEDs) generate a light from a semiconductor material that converts blue light into white light with the use of phosphorus; LEDs do not emit UV rays and, therefore, are a safer light source for the skin.

Lamps that are not used for lighting also must be considered. The Food and Drug Administration recently released a consumer alert regarding the use of UV-curing lamps at nail salons because of the UV radiation emitted. Since daily use of such lamps is not common, the risk of such an exposure is low; but precautions against UV exposure have, nonetheless, been recommended. UV-protectant gloves and application of a broad spectrum sunscreen on the hands prior to use is recommended to decrease the risks of UV exposure to the hands.

In addition to the use of lamps, the light that passes through glass is easy to underestimate. Unlike UVB rays, UVA rays pass through glass and affect the skin. The percentage of UVA rays that pass through glass depends on the type of glass and the coating on the glass. There are three types of window glass: clear, reflective, and tinted. Clear glass allows 75% of UVA through,while reflective and tinted glass allow only 25%-50% of UVA rays to pass through. Low-emissivity glass (Low-E) is made to reduce heat transfer and is similar to clear glass. The most protective glass is laminated or UV-coated glass that filters out 95%-99% of all UVA rays. Unfortunately, most residential and commercial buildings do not have UVA protection. The use of blinds, shades, and tinted glass, and increasing the distance from windows and doors are the best methods of protection from chronic daily UVA exposures.

In most cars, windshield is made of laminated glass (two layers of glass with a layer of plastic in between), which blocks all UVB and approximately 50% of UVA rays. However, side and rear windows are often clear glass, which does not prevent UVA rays from penetrating through. Patients with photosensitive dermatoses and all melasma patients are encouraged to tint the side windows of their vehicles to reduce UVA exposures to 15%-30%. Tinting, however, must be in compliance with federally mandated standard of 70% minimum visible light transmittance. In my practice, daily UV protection is recommended for all patients, even within an automobile or in an office. Daily cumulative exposure can cause chronic skin damage and early signs of photoaging.

Other sources of indoor exposures include TV monitors, computers, tablets, and UV sterilization devices in the workplace. Older cathode ray tube screens emit UV radiation; however, newer liquid crystal display (LCD) or flat panel monitors most commonly on laptops, desktops, and mobile devices do not emit UV radiation. They do emit blue light – although a small fraction compared to that emitted by the sun. The amount of time spent in front of these screens and their proximity can pose a problem as blue light can increase reactive oxygen species, which is the most common contributor to premature aging. These devices also emit heat, which can exacerbate erythema ab igne and other heat-sensitive skin conditions.

Blue light has a very short wavelength with high energy. Studies have shown that permanent eye damage, including macular degeneration, from extended exposure to close-range blue light from computers and tablets is possible. Close-range blue light has been associated with increased skin melanogenesis. Skin hyperpigmentation, such as in lichen planus pigmentosus and melasma, also can be exacerbated by blue light; to prevent the worsening of such conditions, discretion is advised with regard to the use of these devices in close proximity to the skin.

The risks of indoor UV and blue light exposures are commonly overlooked. Skin protection with broad-spectrum sunscreen both inside and outside should be used daily for maximum protection. Care should also be taken to limit exposure times and increase distance of these objects from the skin and eyes.
 

 

Dr. Talakoub and Dr. Wesley are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

References

Autoimmun Rev. 2009;8(4):320-4.

Anais Brasileiros de Dermatologia. 2015;90(4):595-7.

 

It may be surprising that there are dermatologic risks of UV exposure from lamps and other indoor light sources that we use daily. Is long-term daily exposure to presumably low-irradiance lights of clinical significance to photodermatoses? Recent findings suggest that skin protection must be practiced indoors to adequately protect the skin against UV rays.

Photodermatoses, such as lupus, actinic prurigo, and xeroderma pigmentosum, are only a few of the skin diseases that are triggered by UV exposure; however, chronic low-dose exposures to UV light, such as those associated with indoor lighting, may also be triggers of such conditions. Melasma, for example, can be triggered by heat or UV light. Chronic exposure to ambient light may darken the skin, necessitating daily UV protection in both indoor and outdoor settings.

level17/thinkstock

Dermatologists can attest to the number of patients that confess that they only sometimes wear sunscreen “when outside.” If UV exposure to inside lighting has more significant effects on the skin, however, more precautions must be taken to prevent skin cancer, melasma, and other skin damage from exposure through window glass, and from fluorescent bulbs, halogen lamps, and tablet and computer screens.

A study examining light sources in the environment of a child with xeroderma pigmentosum suggested that indoor lights emit unexpected amounts of UV light as measured by a spectral radiometer. This finding illustrated that cumulative, chronic doses of indoor lighting may be of clinical significance.

Interior lighting is also implicated in worsening of melasma and other photosensitive dermatoses. Incandescent bulbs have little to no UV irradiance. However, fluorescent lighting has been shown to increase lifetime UV exposure by 3% based on the distance the lamp is from the skin. If the lamp is close – particularly desk lamps, bed lamps, and overhead lamps – the light and heat emitted can worsen photoexacerbated dermatitidis. Avoiding close contact with the light or adding acrylic or plastic diffusers to the light can help reduce exposure.

Halogen bulbs are filled with an inert gas and a halogen, such as iodine. These bulbs are usually made of quartz because quartz is more resistant to the high heat emitted by these bulbs. But the quartz, however, does not block UV radiation, which is why manufacturers add UV-blocking agents and heat-resistant glass to block the UV; however, the amount blocked is usually unknown. As with fluorescent bulbs, the distance from the bulb is essential to protect against both the UV and heat emitted. Light-emitting diodes (LEDs) generate a light from a semiconductor material that converts blue light into white light with the use of phosphorus; LEDs do not emit UV rays and, therefore, are a safer light source for the skin.

Lamps that are not used for lighting also must be considered. The Food and Drug Administration recently released a consumer alert regarding the use of UV-curing lamps at nail salons because of the UV radiation emitted. Since daily use of such lamps is not common, the risk of such an exposure is low; but precautions against UV exposure have, nonetheless, been recommended. UV-protectant gloves and application of a broad spectrum sunscreen on the hands prior to use is recommended to decrease the risks of UV exposure to the hands.

In addition to the use of lamps, the light that passes through glass is easy to underestimate. Unlike UVB rays, UVA rays pass through glass and affect the skin. The percentage of UVA rays that pass through glass depends on the type of glass and the coating on the glass. There are three types of window glass: clear, reflective, and tinted. Clear glass allows 75% of UVA through,while reflective and tinted glass allow only 25%-50% of UVA rays to pass through. Low-emissivity glass (Low-E) is made to reduce heat transfer and is similar to clear glass. The most protective glass is laminated or UV-coated glass that filters out 95%-99% of all UVA rays. Unfortunately, most residential and commercial buildings do not have UVA protection. The use of blinds, shades, and tinted glass, and increasing the distance from windows and doors are the best methods of protection from chronic daily UVA exposures.

In most cars, windshield is made of laminated glass (two layers of glass with a layer of plastic in between), which blocks all UVB and approximately 50% of UVA rays. However, side and rear windows are often clear glass, which does not prevent UVA rays from penetrating through. Patients with photosensitive dermatoses and all melasma patients are encouraged to tint the side windows of their vehicles to reduce UVA exposures to 15%-30%. Tinting, however, must be in compliance with federally mandated standard of 70% minimum visible light transmittance. In my practice, daily UV protection is recommended for all patients, even within an automobile or in an office. Daily cumulative exposure can cause chronic skin damage and early signs of photoaging.

Other sources of indoor exposures include TV monitors, computers, tablets, and UV sterilization devices in the workplace. Older cathode ray tube screens emit UV radiation; however, newer liquid crystal display (LCD) or flat panel monitors most commonly on laptops, desktops, and mobile devices do not emit UV radiation. They do emit blue light – although a small fraction compared to that emitted by the sun. The amount of time spent in front of these screens and their proximity can pose a problem as blue light can increase reactive oxygen species, which is the most common contributor to premature aging. These devices also emit heat, which can exacerbate erythema ab igne and other heat-sensitive skin conditions.

Blue light has a very short wavelength with high energy. Studies have shown that permanent eye damage, including macular degeneration, from extended exposure to close-range blue light from computers and tablets is possible. Close-range blue light has been associated with increased skin melanogenesis. Skin hyperpigmentation, such as in lichen planus pigmentosus and melasma, also can be exacerbated by blue light; to prevent the worsening of such conditions, discretion is advised with regard to the use of these devices in close proximity to the skin.

The risks of indoor UV and blue light exposures are commonly overlooked. Skin protection with broad-spectrum sunscreen both inside and outside should be used daily for maximum protection. Care should also be taken to limit exposure times and increase distance of these objects from the skin and eyes.
 

 

Dr. Talakoub and Dr. Wesley are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

References

Autoimmun Rev. 2009;8(4):320-4.

Anais Brasileiros de Dermatologia. 2015;90(4):595-7.

In a large country of only 3 million people (where wild horses outnumber people), with an estimated 2 million who live in the capital and 1 million who live a traditional nomadic lifestyle, traditional skin care and beauty practices can still be found.

In the capital city of Ulaanbaatar, women practice many of the same beauty regimens as those of women in other parts of mainstream Asia, with access to department store beauty counters and shopping malls found in major cities throughout the world. With the influx of movies and media into Mongolia from South Korea in the late 1990s, South Korean beauty regimens and standards have weaved their way into the urban culture. However, in rural Mongolia, where a nomadic way of life still predominates, certain beauty and cultural practices remain intact without the influence of mainstream culture.

While lucky enough to travel to rural Mongolia on a medical volunteer trip this summer, I was able to witness and inquire about some of these practices. I was extremely fortunate to meet and befriend a Mongolian woman, Tuvdendorj Dulguun, who shared some of these skin care secrets with me.

Homemade yogurt, a staple in rural Mongolia, is used on the face to help brighten the skin. In rural Mongolia, the yogurt is made and eaten fresh, thus lasts for 1-2 days if not refrigerated. The yogurt comes from cows and goats (rarely from other animals) that graze on open land without pesticides and are not fed hormones and grains. My personal diet doesn’t consist of much dairy, but I can say firsthand that in my opinion, it is delicious there. Yogurt is also applied to the skin to treat acne, but for acne the yogurt is fermented more than usual, so there is more acid to reduce the skin inflammation. (Lactic acid is typically what is found in fermented yogurt.)

Another secret is the use of sheep tail fat on the skin. A well fed sheep collects and stores a large amount of fat in the lower back and tail as an energy reserve – easily recognizable as a “fat bottom” on the animal. A mutton (older sheep only), when consumed, is typically prepared for special occasions, such as the new year’s festival “Tsagaan Sar” or a wedding. Sheep tail fat is thought to have more collagen and provide more moisturization than other beauty products, especially in the sometimes harsh, arid climate of Mongolia. This tradition is fading, but Tuvdendorj’s aunt still uses it and has beautiful skin. The fat in the sheep’s tail is full of nutrients, and is what’s used for human skin. Healthy fats have omega-3 fatty acids, which are anti-inflammatory, and contain essential fatty acids plus fat soluble vitamins – A, D, E, and K – which can be helpful for skin. Grass fed-animals tend to have more omega-3 fatty acids, whereas grain-fed animals tend to have more omega-6 than omega-3 fatty acids.

Headdresses, traditional clothing, and adornments are seen in traditional Mongolia, particularly during the Naadam festival. With naturally high cheek bones and oval eyes that have epicanthic folds, many Mongolian women have distinct features. Long black braided hair is seen as an adornment during festivals. In rural Mongolia, it is not uncommon to see rosy red cheeks, flushed with telangiectasias due to sun, wind, and snow. In the capital city, the distinctive telangiectatic cheeks are not seen as frequently; instead, many women wear eyeliner to highlight their oval eyes. With my mother’s side of the family being direct descendants of Mongolia to the Middle East, I found these beauty practices to be fascinating and they hold a special place in my heart.
 

Dr. Wesley and Dr. Talakoub are co-contributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

Resource:

1. J Altern Complement Med. 2015 Jul;21(7):380-5.

In a large country of only 3 million people (where wild horses outnumber people), with an estimated 2 million who live in the capital and 1 million who live a traditional nomadic lifestyle, traditional skin care and beauty practices can still be found.

In the capital city of Ulaanbaatar, women practice many of the same beauty regimens as those of women in other parts of mainstream Asia, with access to department store beauty counters and shopping malls found in major cities throughout the world. With the influx of movies and media into Mongolia from South Korea in the late 1990s, South Korean beauty regimens and standards have weaved their way into the urban culture. However, in rural Mongolia, where a nomadic way of life still predominates, certain beauty and cultural practices remain intact without the influence of mainstream culture.

While lucky enough to travel to rural Mongolia on a medical volunteer trip this summer, I was able to witness and inquire about some of these practices. I was extremely fortunate to meet and befriend a Mongolian woman, Tuvdendorj Dulguun, who shared some of these skin care secrets with me.

Homemade yogurt, a staple in rural Mongolia, is used on the face to help brighten the skin. In rural Mongolia, the yogurt is made and eaten fresh, thus lasts for 1-2 days if not refrigerated. The yogurt comes from cows and goats (rarely from other animals) that graze on open land without pesticides and are not fed hormones and grains. My personal diet doesn’t consist of much dairy, but I can say firsthand that in my opinion, it is delicious there. Yogurt is also applied to the skin to treat acne, but for acne the yogurt is fermented more than usual, so there is more acid to reduce the skin inflammation. (Lactic acid is typically what is found in fermented yogurt.)

Another secret is the use of sheep tail fat on the skin. A well fed sheep collects and stores a large amount of fat in the lower back and tail as an energy reserve – easily recognizable as a “fat bottom” on the animal. A mutton (older sheep only), when consumed, is typically prepared for special occasions, such as the new year’s festival “Tsagaan Sar” or a wedding. Sheep tail fat is thought to have more collagen and provide more moisturization than other beauty products, especially in the sometimes harsh, arid climate of Mongolia. This tradition is fading, but Tuvdendorj’s aunt still uses it and has beautiful skin. The fat in the sheep’s tail is full of nutrients, and is what’s used for human skin. Healthy fats have omega-3 fatty acids, which are anti-inflammatory, and contain essential fatty acids plus fat soluble vitamins – A, D, E, and K – which can be helpful for skin. Grass fed-animals tend to have more omega-3 fatty acids, whereas grain-fed animals tend to have more omega-6 than omega-3 fatty acids.

Headdresses, traditional clothing, and adornments are seen in traditional Mongolia, particularly during the Naadam festival. With naturally high cheek bones and oval eyes that have epicanthic folds, many Mongolian women have distinct features. Long black braided hair is seen as an adornment during festivals. In rural Mongolia, it is not uncommon to see rosy red cheeks, flushed with telangiectasias due to sun, wind, and snow. In the capital city, the distinctive telangiectatic cheeks are not seen as frequently; instead, many women wear eyeliner to highlight their oval eyes. With my mother’s side of the family being direct descendants of Mongolia to the Middle East, I found these beauty practices to be fascinating and they hold a special place in my heart.
 

Dr. Wesley and Dr. Talakoub are co-contributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

Resource:

1. J Altern Complement Med. 2015 Jul;21(7):380-5.

In a large country of only 3 million people (where wild horses outnumber people), with an estimated 2 million who live in the capital and 1 million who live a traditional nomadic lifestyle, traditional skin care and beauty practices can still be found.

In the capital city of Ulaanbaatar, women practice many of the same beauty regimens as those of women in other parts of mainstream Asia, with access to department store beauty counters and shopping malls found in major cities throughout the world. With the influx of movies and media into Mongolia from South Korea in the late 1990s, South Korean beauty regimens and standards have weaved their way into the urban culture. However, in rural Mongolia, where a nomadic way of life still predominates, certain beauty and cultural practices remain intact without the influence of mainstream culture.

While lucky enough to travel to rural Mongolia on a medical volunteer trip this summer, I was able to witness and inquire about some of these practices. I was extremely fortunate to meet and befriend a Mongolian woman, Tuvdendorj Dulguun, who shared some of these skin care secrets with me.

Homemade yogurt, a staple in rural Mongolia, is used on the face to help brighten the skin. In rural Mongolia, the yogurt is made and eaten fresh, thus lasts for 1-2 days if not refrigerated. The yogurt comes from cows and goats (rarely from other animals) that graze on open land without pesticides and are not fed hormones and grains. My personal diet doesn’t consist of much dairy, but I can say firsthand that in my opinion, it is delicious there. Yogurt is also applied to the skin to treat acne, but for acne the yogurt is fermented more than usual, so there is more acid to reduce the skin inflammation. (Lactic acid is typically what is found in fermented yogurt.)

Another secret is the use of sheep tail fat on the skin. A well fed sheep collects and stores a large amount of fat in the lower back and tail as an energy reserve – easily recognizable as a “fat bottom” on the animal. A mutton (older sheep only), when consumed, is typically prepared for special occasions, such as the new year’s festival “Tsagaan Sar” or a wedding. Sheep tail fat is thought to have more collagen and provide more moisturization than other beauty products, especially in the sometimes harsh, arid climate of Mongolia. This tradition is fading, but Tuvdendorj’s aunt still uses it and has beautiful skin. The fat in the sheep’s tail is full of nutrients, and is what’s used for human skin. Healthy fats have omega-3 fatty acids, which are anti-inflammatory, and contain essential fatty acids plus fat soluble vitamins – A, D, E, and K – which can be helpful for skin. Grass fed-animals tend to have more omega-3 fatty acids, whereas grain-fed animals tend to have more omega-6 than omega-3 fatty acids.

Headdresses, traditional clothing, and adornments are seen in traditional Mongolia, particularly during the Naadam festival. With naturally high cheek bones and oval eyes that have epicanthic folds, many Mongolian women have distinct features. Long black braided hair is seen as an adornment during festivals. In rural Mongolia, it is not uncommon to see rosy red cheeks, flushed with telangiectasias due to sun, wind, and snow. In the capital city, the distinctive telangiectatic cheeks are not seen as frequently; instead, many women wear eyeliner to highlight their oval eyes. With my mother’s side of the family being direct descendants of Mongolia to the Middle East, I found these beauty practices to be fascinating and they hold a special place in my heart.
 

Dr. Wesley and Dr. Talakoub are co-contributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

Resource:

1. J Altern Complement Med. 2015 Jul;21(7):380-5.

 

The therapeutic benefits of plant oils have been documented for hundreds of years. The properties of medicinal and aromatic plants have been explored for their essential oils. Essential oils are synthesized and used in a multibillion dollar global market for their curative properties, which include antimicrobial, antioxidant, anti-inflammatory, chemoprotective, antiproliferative, antiatherogenic, and antidiabetic properties. More than 80% of the global population depends on traditional plant-based medicine for treating health problems. There are currently over 3,000 known essential oils, among which 300 are commercially available for food, pharmaceutical, cosmetic, sanitary, and perfume industries. The extraction of these oils and their use in cosmeceuticals has increased in the last decade, as minor ingredients in creams and skin cleansing preparations.

However, these oils are now being marketed for direct application on the skin. What’s the hype about facial oils and why are there hundreds currently on the market?

Contrary to popular belief, oils are not solely for dry skin. Plant-based oils are filled with essential fatty acids, vitamins, and antioxidants that act to strengthen the skin’s protective barrier, prevent free radical damage, and increase skin elasticity. The chemical constituents of plant essential oils differ among species. Factors influencing these constituents include geographical location, environment, and stage of maturity of the plant. Furthermore, the stereochemical properties of essential oils can vary and depend on the method of extraction. There are over fifty different types of fatty acids in oils, and each oil has its own unique composition.

Choosing the right oil, however, is not easy. Most consumers shy away from pure oils because they fear breakouts or increased “oiliness” of their skin. Understanding the properties of the oils can help determine which oils will benefit specific skin types. Argan oil and sunflower oil, for example, are rich in essential fatty acids and vitamin E, which hydrate the skin and have antiaging properties. Tea tree oil has antibacterial and anti-inflammatory qualities which are great for acne-prone skin. Oils such as these are particularly effective if acne medications are used. Acne medications can strip the natural barrier of the skin and without proper hydration excess sebum is produced and can cause clogging of pores.

Skin oils help to repair the skin barrier and train the skin to rebalance itself if overstripped from harsh cleansers or medications. Rosehip seed oil, previously used by Native Americans for its healing properties, has regained popularity because it is a rich source of Vitamin E, C, D, A, and essential fatty acids. Cosmetic preparations of rosehip oil have been used for hydration, scar reduction, stretch marks, and decreasing facial erythema with rosacea.

Essential oils have antiaging properties as well. A study of sixty postmenopausal women who received oral or topical argan oil had significantly improved elasticity of the skin after 60 days, compared with the consumption of olive oil, which produced no improvement of skin elasticity. Sunflower oil has been used in skin preparations for its rich antioxidant properties, which decrease free radical damage from UV radiation.

The use of oils is multidimensional. Oils are highly effective for removing makeup and are the best source for cleansing of dry, dehydrated, or sensitive skin. Similarly, oils applied to the hair can help restore the natural oils of the hair, which are often stripped from overwashing and from chemical hair treatments. Facial oils also help improve skin hydration and restore the natural barrier of the skin. In addition, facial oils can be used in place of moisturizers or under a moisturizer to help prevent transepidermal water loss in dehydrated or atopic skin.

But these oils have a downside. Fragrant plant-based oils can cause skin irritation, photosensitivity, and potentially, allergic reactions. Consumers with plant-based allergies or sensitive skin should therefore steer clear of fragrant oils and test every oil on their inner forearm prior to applying them on the face.

I am a believer in these products. Oils have come a long way in cosmetic products and their manufacturing process has been improved over the last decade, making them easy to use, noncomedogenic, and nongreasy. They are an essential part of skin care for anyone with inflamed, dry, or irritated skin. More cosmetically elegant than their predecessors, when used correctly, oils are among the best products in the cosmeceutical market today.

Dr. Wesley and Dr. Talakoub are cocontributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

 

References

J Pharm Pharmacol. 2010 Dec;62(12):1669-75.

Inflamm Allergy Drug Targets. 2014;13(3):168-76.

Issue Biol. Sci. Pharm. Res. 2(1):001-007.

Evid Based Complement Alternat Med. 2017;2017:4517971.

Clin Interv Aging. 2015; 10: 339-49.

Evid Based Complement Alternat Med. 2013;2013:827248.

Dermatoendocrinol. 2012 Jul 1;4(3):298-307.

http://www.circulating-oils-library.com/en/start.

 

The therapeutic benefits of plant oils have been documented for hundreds of years. The properties of medicinal and aromatic plants have been explored for their essential oils. Essential oils are synthesized and used in a multibillion dollar global market for their curative properties, which include antimicrobial, antioxidant, anti-inflammatory, chemoprotective, antiproliferative, antiatherogenic, and antidiabetic properties. More than 80% of the global population depends on traditional plant-based medicine for treating health problems. There are currently over 3,000 known essential oils, among which 300 are commercially available for food, pharmaceutical, cosmetic, sanitary, and perfume industries. The extraction of these oils and their use in cosmeceuticals has increased in the last decade, as minor ingredients in creams and skin cleansing preparations.

However, these oils are now being marketed for direct application on the skin. What’s the hype about facial oils and why are there hundreds currently on the market?

Contrary to popular belief, oils are not solely for dry skin. Plant-based oils are filled with essential fatty acids, vitamins, and antioxidants that act to strengthen the skin’s protective barrier, prevent free radical damage, and increase skin elasticity. The chemical constituents of plant essential oils differ among species. Factors influencing these constituents include geographical location, environment, and stage of maturity of the plant. Furthermore, the stereochemical properties of essential oils can vary and depend on the method of extraction. There are over fifty different types of fatty acids in oils, and each oil has its own unique composition.

Choosing the right oil, however, is not easy. Most consumers shy away from pure oils because they fear breakouts or increased “oiliness” of their skin. Understanding the properties of the oils can help determine which oils will benefit specific skin types. Argan oil and sunflower oil, for example, are rich in essential fatty acids and vitamin E, which hydrate the skin and have antiaging properties. Tea tree oil has antibacterial and anti-inflammatory qualities which are great for acne-prone skin. Oils such as these are particularly effective if acne medications are used. Acne medications can strip the natural barrier of the skin and without proper hydration excess sebum is produced and can cause clogging of pores.

Skin oils help to repair the skin barrier and train the skin to rebalance itself if overstripped from harsh cleansers or medications. Rosehip seed oil, previously used by Native Americans for its healing properties, has regained popularity because it is a rich source of Vitamin E, C, D, A, and essential fatty acids. Cosmetic preparations of rosehip oil have been used for hydration, scar reduction, stretch marks, and decreasing facial erythema with rosacea.

Essential oils have antiaging properties as well. A study of sixty postmenopausal women who received oral or topical argan oil had significantly improved elasticity of the skin after 60 days, compared with the consumption of olive oil, which produced no improvement of skin elasticity. Sunflower oil has been used in skin preparations for its rich antioxidant properties, which decrease free radical damage from UV radiation.

The use of oils is multidimensional. Oils are highly effective for removing makeup and are the best source for cleansing of dry, dehydrated, or sensitive skin. Similarly, oils applied to the hair can help restore the natural oils of the hair, which are often stripped from overwashing and from chemical hair treatments. Facial oils also help improve skin hydration and restore the natural barrier of the skin. In addition, facial oils can be used in place of moisturizers or under a moisturizer to help prevent transepidermal water loss in dehydrated or atopic skin.

But these oils have a downside. Fragrant plant-based oils can cause skin irritation, photosensitivity, and potentially, allergic reactions. Consumers with plant-based allergies or sensitive skin should therefore steer clear of fragrant oils and test every oil on their inner forearm prior to applying them on the face.

I am a believer in these products. Oils have come a long way in cosmetic products and their manufacturing process has been improved over the last decade, making them easy to use, noncomedogenic, and nongreasy. They are an essential part of skin care for anyone with inflamed, dry, or irritated skin. More cosmetically elegant than their predecessors, when used correctly, oils are among the best products in the cosmeceutical market today.

Dr. Wesley and Dr. Talakoub are cocontributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

 

References

J Pharm Pharmacol. 2010 Dec;62(12):1669-75.

Inflamm Allergy Drug Targets. 2014;13(3):168-76.

Issue Biol. Sci. Pharm. Res. 2(1):001-007.

Evid Based Complement Alternat Med. 2017;2017:4517971.

Clin Interv Aging. 2015; 10: 339-49.

Evid Based Complement Alternat Med. 2013;2013:827248.

Dermatoendocrinol. 2012 Jul 1;4(3):298-307.

http://www.circulating-oils-library.com/en/start.

 

The therapeutic benefits of plant oils have been documented for hundreds of years. The properties of medicinal and aromatic plants have been explored for their essential oils. Essential oils are synthesized and used in a multibillion dollar global market for their curative properties, which include antimicrobial, antioxidant, anti-inflammatory, chemoprotective, antiproliferative, antiatherogenic, and antidiabetic properties. More than 80% of the global population depends on traditional plant-based medicine for treating health problems. There are currently over 3,000 known essential oils, among which 300 are commercially available for food, pharmaceutical, cosmetic, sanitary, and perfume industries. The extraction of these oils and their use in cosmeceuticals has increased in the last decade, as minor ingredients in creams and skin cleansing preparations.

However, these oils are now being marketed for direct application on the skin. What’s the hype about facial oils and why are there hundreds currently on the market?

Contrary to popular belief, oils are not solely for dry skin. Plant-based oils are filled with essential fatty acids, vitamins, and antioxidants that act to strengthen the skin’s protective barrier, prevent free radical damage, and increase skin elasticity. The chemical constituents of plant essential oils differ among species. Factors influencing these constituents include geographical location, environment, and stage of maturity of the plant. Furthermore, the stereochemical properties of essential oils can vary and depend on the method of extraction. There are over fifty different types of fatty acids in oils, and each oil has its own unique composition.

Choosing the right oil, however, is not easy. Most consumers shy away from pure oils because they fear breakouts or increased “oiliness” of their skin. Understanding the properties of the oils can help determine which oils will benefit specific skin types. Argan oil and sunflower oil, for example, are rich in essential fatty acids and vitamin E, which hydrate the skin and have antiaging properties. Tea tree oil has antibacterial and anti-inflammatory qualities which are great for acne-prone skin. Oils such as these are particularly effective if acne medications are used. Acne medications can strip the natural barrier of the skin and without proper hydration excess sebum is produced and can cause clogging of pores.

Skin oils help to repair the skin barrier and train the skin to rebalance itself if overstripped from harsh cleansers or medications. Rosehip seed oil, previously used by Native Americans for its healing properties, has regained popularity because it is a rich source of Vitamin E, C, D, A, and essential fatty acids. Cosmetic preparations of rosehip oil have been used for hydration, scar reduction, stretch marks, and decreasing facial erythema with rosacea.

Essential oils have antiaging properties as well. A study of sixty postmenopausal women who received oral or topical argan oil had significantly improved elasticity of the skin after 60 days, compared with the consumption of olive oil, which produced no improvement of skin elasticity. Sunflower oil has been used in skin preparations for its rich antioxidant properties, which decrease free radical damage from UV radiation.

The use of oils is multidimensional. Oils are highly effective for removing makeup and are the best source for cleansing of dry, dehydrated, or sensitive skin. Similarly, oils applied to the hair can help restore the natural oils of the hair, which are often stripped from overwashing and from chemical hair treatments. Facial oils also help improve skin hydration and restore the natural barrier of the skin. In addition, facial oils can be used in place of moisturizers or under a moisturizer to help prevent transepidermal water loss in dehydrated or atopic skin.

But these oils have a downside. Fragrant plant-based oils can cause skin irritation, photosensitivity, and potentially, allergic reactions. Consumers with plant-based allergies or sensitive skin should therefore steer clear of fragrant oils and test every oil on their inner forearm prior to applying them on the face.

I am a believer in these products. Oils have come a long way in cosmetic products and their manufacturing process has been improved over the last decade, making them easy to use, noncomedogenic, and nongreasy. They are an essential part of skin care for anyone with inflamed, dry, or irritated skin. More cosmetically elegant than their predecessors, when used correctly, oils are among the best products in the cosmeceutical market today.

Dr. Wesley and Dr. Talakoub are cocontributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

 

References

J Pharm Pharmacol. 2010 Dec;62(12):1669-75.

Inflamm Allergy Drug Targets. 2014;13(3):168-76.

Issue Biol. Sci. Pharm. Res. 2(1):001-007.

Evid Based Complement Alternat Med. 2017;2017:4517971.

Clin Interv Aging. 2015; 10: 339-49.

Evid Based Complement Alternat Med. 2013;2013:827248.

Dermatoendocrinol. 2012 Jul 1;4(3):298-307.

http://www.circulating-oils-library.com/en/start.

 

Besides skin wrinkling, volume shifts, and photoaging, graying hair can also be a telltale sign of aging. While it was recently a fashionable trend for younger persons to dye their hair white or gray, graying hair can make a younger person appear older, even in those with naturally premature graying of the hair.

In a study recently published in Genes & Development, researchers at the University of Texas Southwestern Medical Center, Dallas, identified hair shaft progenitors in the matrix that are specific to the hair shaft and not to follicular epithelial cells.¹ These hair shaft progenitors express transcription factor KROX20, which expresses stem cell growth factor necessary for hair pigmentation by maintenance of differentiated melanocytes. When KROX20+ is depleted, hair growth is halted and hair turns gray, proving its important role in both hair growth and graying pathways.

Other mechanisms for hair graying include oxidative stress to the hair, at the level of the melanocyte stem cell or at the end-stage of the hair melanocyte, resulting in follicular melanocyte death. With aging and certain genetic mutations (such as that seen in Chediak-Higashi syndrome), reduction of catalase and sometimes downregulation of antioxidant proteins such as BCL-2 and TRP-2 are reduced, resulting in higher reactive oxygen species (ROS) that lead to bulbar melanocyte malfunction and death.

Last year, for the first time, researchers at University College of London identified a gene involved in gray hair, the interferon regulatory factor 4 gene (IRF4).² The IRF4 gene is involved in regulating production and storage of melanin.

Besides photoprotection and vitamin antioxidants as a preventive measure, therapies that have been developed to target the reduction of ROS in hair have been largely unsatisfactory in treating gray hair. Most people either allow their hair to gray or dye their hair, which can be time consuming and costly and is required on a more frequent basis over time – not to mention the distress related to allergic contact dermatitis caused by some components of some hair dyes, including paraphenylenediamine, which we sometimes see in our profession.

Knowledge of KROX20+, the IRF4 gene, and other pathways involved may be useful in developing novel treatments to prevent or treat graying hair. Information regarding the use of platelet rich plasma (PRP) for hair growth is increasingly being published in the literature. While some physicians purport seeing a reversal in graying with scalp PRP injections, the majority say the results are not universal.

Currently, there are no published studies evaluating the effects of PRP on gray hair. Perhaps providing stem cell factors via injections of PRP or other growth factors may aid not only in hair regrowth but in preserving pigmentation and repigmentation.

Dr. Wesley and Dr. Talakoub are cocontributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.
 

References:

1. Genes Dev. 2017 May 2. doi: 10.1101/gad.298703.117.

2. Nat Commun. 2016 Mar 1;7:10815.

 

Besides skin wrinkling, volume shifts, and photoaging, graying hair can also be a telltale sign of aging. While it was recently a fashionable trend for younger persons to dye their hair white or gray, graying hair can make a younger person appear older, even in those with naturally premature graying of the hair.

In a study recently published in Genes & Development, researchers at the University of Texas Southwestern Medical Center, Dallas, identified hair shaft progenitors in the matrix that are specific to the hair shaft and not to follicular epithelial cells.¹ These hair shaft progenitors express transcription factor KROX20, which expresses stem cell growth factor necessary for hair pigmentation by maintenance of differentiated melanocytes. When KROX20+ is depleted, hair growth is halted and hair turns gray, proving its important role in both hair growth and graying pathways.

Other mechanisms for hair graying include oxidative stress to the hair, at the level of the melanocyte stem cell or at the end-stage of the hair melanocyte, resulting in follicular melanocyte death. With aging and certain genetic mutations (such as that seen in Chediak-Higashi syndrome), reduction of catalase and sometimes downregulation of antioxidant proteins such as BCL-2 and TRP-2 are reduced, resulting in higher reactive oxygen species (ROS) that lead to bulbar melanocyte malfunction and death.

Last year, for the first time, researchers at University College of London identified a gene involved in gray hair, the interferon regulatory factor 4 gene (IRF4).² The IRF4 gene is involved in regulating production and storage of melanin.

Besides photoprotection and vitamin antioxidants as a preventive measure, therapies that have been developed to target the reduction of ROS in hair have been largely unsatisfactory in treating gray hair. Most people either allow their hair to gray or dye their hair, which can be time consuming and costly and is required on a more frequent basis over time – not to mention the distress related to allergic contact dermatitis caused by some components of some hair dyes, including paraphenylenediamine, which we sometimes see in our profession.

Knowledge of KROX20+, the IRF4 gene, and other pathways involved may be useful in developing novel treatments to prevent or treat graying hair. Information regarding the use of platelet rich plasma (PRP) for hair growth is increasingly being published in the literature. While some physicians purport seeing a reversal in graying with scalp PRP injections, the majority say the results are not universal.

Currently, there are no published studies evaluating the effects of PRP on gray hair. Perhaps providing stem cell factors via injections of PRP or other growth factors may aid not only in hair regrowth but in preserving pigmentation and repigmentation.

Dr. Wesley and Dr. Talakoub are cocontributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.
 

References:

1. Genes Dev. 2017 May 2. doi: 10.1101/gad.298703.117.

2. Nat Commun. 2016 Mar 1;7:10815.

 

Besides skin wrinkling, volume shifts, and photoaging, graying hair can also be a telltale sign of aging. While it was recently a fashionable trend for younger persons to dye their hair white or gray, graying hair can make a younger person appear older, even in those with naturally premature graying of the hair.

In a study recently published in Genes & Development, researchers at the University of Texas Southwestern Medical Center, Dallas, identified hair shaft progenitors in the matrix that are specific to the hair shaft and not to follicular epithelial cells.¹ These hair shaft progenitors express transcription factor KROX20, which expresses stem cell growth factor necessary for hair pigmentation by maintenance of differentiated melanocytes. When KROX20+ is depleted, hair growth is halted and hair turns gray, proving its important role in both hair growth and graying pathways.

Other mechanisms for hair graying include oxidative stress to the hair, at the level of the melanocyte stem cell or at the end-stage of the hair melanocyte, resulting in follicular melanocyte death. With aging and certain genetic mutations (such as that seen in Chediak-Higashi syndrome), reduction of catalase and sometimes downregulation of antioxidant proteins such as BCL-2 and TRP-2 are reduced, resulting in higher reactive oxygen species (ROS) that lead to bulbar melanocyte malfunction and death.

Last year, for the first time, researchers at University College of London identified a gene involved in gray hair, the interferon regulatory factor 4 gene (IRF4).² The IRF4 gene is involved in regulating production and storage of melanin.

Besides photoprotection and vitamin antioxidants as a preventive measure, therapies that have been developed to target the reduction of ROS in hair have been largely unsatisfactory in treating gray hair. Most people either allow their hair to gray or dye their hair, which can be time consuming and costly and is required on a more frequent basis over time – not to mention the distress related to allergic contact dermatitis caused by some components of some hair dyes, including paraphenylenediamine, which we sometimes see in our profession.

Knowledge of KROX20+, the IRF4 gene, and other pathways involved may be useful in developing novel treatments to prevent or treat graying hair. Information regarding the use of platelet rich plasma (PRP) for hair growth is increasingly being published in the literature. While some physicians purport seeing a reversal in graying with scalp PRP injections, the majority say the results are not universal.

Currently, there are no published studies evaluating the effects of PRP on gray hair. Perhaps providing stem cell factors via injections of PRP or other growth factors may aid not only in hair regrowth but in preserving pigmentation and repigmentation.

Dr. Wesley and Dr. Talakoub are cocontributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.
 

References:

1. Genes Dev. 2017 May 2. doi: 10.1101/gad.298703.117.

2. Nat Commun. 2016 Mar 1;7:10815.

 

Observational studies suggest that hard water is associated with the development of atopic dermatitis (AD). Studies of children in the United Kingdom, Spain, and Japan show the prevalence of AD is significantly higher in the highest water hardness categories than that in the lowest. Calcium cations in water can interfere with normal epidermal calcium gradients that are necessary for corneocyte development and proper stratum corneum barrier formation.

Water hardness, determined by the amount of dissolved calcium and magnesium in the water, varies by geography and mineral content of the water supply. The hardest water supply in the United States is mostly localized to the Upper Plains and Rocky Mountain areas. General guidelines for classification of waters are: 0-60 mg/L calcium carbonate (soft); 61-120 mg/L (moderately hard); 121-180 mg/L (hard); and more than 180 mg/L (very hard). In regions where there is hard water, the surfactants in soap, such as sodium dodecyl sulfate, react with the calcium and magnesium ions in hard water, resulting in precipitation of the surfactant – leaving a film of residue on the skin, shower tiles, pipes, glassware, etc.

Maibach et al. also described water as a contact irritant, particularly under occlusion. Skin occluded with water has increased histopathologic inflammation, scaling, and barrier breakdown. In addition to than mineral content, pH, temperature, and osmolarity can be contributing factors to the irritancy of water. However, compared with “soft water,” skin exposed to hard water has increased dilution of the natural moisturizing factors and alteration of the corneocyte layers, resulting in increased disruption of the protective epidermal barrier.

Atopic dermatitis, xerosis, and pruritus are some of the common skin reactions to hard water. Other less-well-defined effects on the skin include clogged pores and acne from surfactant residue left on the skin and altered sebum production. In addition, more surfactants or cleansers are needed to clean the skin and hair in areas with hard water because the abundant cations require a much heavier lather to dissolve.

Calcium and magnesium cations left on the skin can also form free radicals. Free radicals over time can result in collagen and elastin breakdown and in the increased prevalence of fine lines and wrinkles.

Although there is no definitive solution to geographic increases of water mineral content, water softeners have grown in popularity over the last decade and in my practice are recommended to anyone with atopic dermatitis that is resistant to treatment or is recalcitrant. These home appliances work though an ion exchange system in which a resin or organic polymer replaces the magnesium and calcium in the water with sodium or potassium cations. When all the sodium or potassium ions have been replaced in the resin, the resin is then “recharged” with a solution of sodium hydroxide (lye) or potassium hydroxide. Alternative less popular softening techniques include lime softening, chelating agents, distillation, and reverse osmosis.

Hard water and geography should be considered a possible factor when assessing patients with recalcitrant eczema, pruritus, or xerosis that cannot otherwise be reversed. Water softening treatments are a simple solution in areas where the mineral content of water is elevated or the water plays a role in clinical skin disease.


 

Dr. Lily Talakoub and Dr. Naissan O. Wesley and are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

References

United States Geological Survey Water Quality Information: Water Hardness and Alkalinity.

J Am Acad Dermatol. 1987 Jun;16(6):1263-4.

Contact Dermatitis. 1996 Dec;35(6):337-43.

Lancet. 1998 Aug 15;352(9127):527-31.

Contact Dermatitis. 1999;41(6):311-4.

Environ Res. 2004 Jan;94(1):33-7.

 

Observational studies suggest that hard water is associated with the development of atopic dermatitis (AD). Studies of children in the United Kingdom, Spain, and Japan show the prevalence of AD is significantly higher in the highest water hardness categories than that in the lowest. Calcium cations in water can interfere with normal epidermal calcium gradients that are necessary for corneocyte development and proper stratum corneum barrier formation.

Water hardness, determined by the amount of dissolved calcium and magnesium in the water, varies by geography and mineral content of the water supply. The hardest water supply in the United States is mostly localized to the Upper Plains and Rocky Mountain areas. General guidelines for classification of waters are: 0-60 mg/L calcium carbonate (soft); 61-120 mg/L (moderately hard); 121-180 mg/L (hard); and more than 180 mg/L (very hard). In regions where there is hard water, the surfactants in soap, such as sodium dodecyl sulfate, react with the calcium and magnesium ions in hard water, resulting in precipitation of the surfactant – leaving a film of residue on the skin, shower tiles, pipes, glassware, etc.

Maibach et al. also described water as a contact irritant, particularly under occlusion. Skin occluded with water has increased histopathologic inflammation, scaling, and barrier breakdown. In addition to than mineral content, pH, temperature, and osmolarity can be contributing factors to the irritancy of water. However, compared with “soft water,” skin exposed to hard water has increased dilution of the natural moisturizing factors and alteration of the corneocyte layers, resulting in increased disruption of the protective epidermal barrier.

Atopic dermatitis, xerosis, and pruritus are some of the common skin reactions to hard water. Other less-well-defined effects on the skin include clogged pores and acne from surfactant residue left on the skin and altered sebum production. In addition, more surfactants or cleansers are needed to clean the skin and hair in areas with hard water because the abundant cations require a much heavier lather to dissolve.

Calcium and magnesium cations left on the skin can also form free radicals. Free radicals over time can result in collagen and elastin breakdown and in the increased prevalence of fine lines and wrinkles.

Although there is no definitive solution to geographic increases of water mineral content, water softeners have grown in popularity over the last decade and in my practice are recommended to anyone with atopic dermatitis that is resistant to treatment or is recalcitrant. These home appliances work though an ion exchange system in which a resin or organic polymer replaces the magnesium and calcium in the water with sodium or potassium cations. When all the sodium or potassium ions have been replaced in the resin, the resin is then “recharged” with a solution of sodium hydroxide (lye) or potassium hydroxide. Alternative less popular softening techniques include lime softening, chelating agents, distillation, and reverse osmosis.

Hard water and geography should be considered a possible factor when assessing patients with recalcitrant eczema, pruritus, or xerosis that cannot otherwise be reversed. Water softening treatments are a simple solution in areas where the mineral content of water is elevated or the water plays a role in clinical skin disease.


 

Dr. Lily Talakoub and Dr. Naissan O. Wesley and are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

References

United States Geological Survey Water Quality Information: Water Hardness and Alkalinity.

J Am Acad Dermatol. 1987 Jun;16(6):1263-4.

Contact Dermatitis. 1996 Dec;35(6):337-43.

Lancet. 1998 Aug 15;352(9127):527-31.

Contact Dermatitis. 1999;41(6):311-4.

Environ Res. 2004 Jan;94(1):33-7.

 

Observational studies suggest that hard water is associated with the development of atopic dermatitis (AD). Studies of children in the United Kingdom, Spain, and Japan show the prevalence of AD is significantly higher in the highest water hardness categories than that in the lowest. Calcium cations in water can interfere with normal epidermal calcium gradients that are necessary for corneocyte development and proper stratum corneum barrier formation.

Water hardness, determined by the amount of dissolved calcium and magnesium in the water, varies by geography and mineral content of the water supply. The hardest water supply in the United States is mostly localized to the Upper Plains and Rocky Mountain areas. General guidelines for classification of waters are: 0-60 mg/L calcium carbonate (soft); 61-120 mg/L (moderately hard); 121-180 mg/L (hard); and more than 180 mg/L (very hard). In regions where there is hard water, the surfactants in soap, such as sodium dodecyl sulfate, react with the calcium and magnesium ions in hard water, resulting in precipitation of the surfactant – leaving a film of residue on the skin, shower tiles, pipes, glassware, etc.

Maibach et al. also described water as a contact irritant, particularly under occlusion. Skin occluded with water has increased histopathologic inflammation, scaling, and barrier breakdown. In addition to than mineral content, pH, temperature, and osmolarity can be contributing factors to the irritancy of water. However, compared with “soft water,” skin exposed to hard water has increased dilution of the natural moisturizing factors and alteration of the corneocyte layers, resulting in increased disruption of the protective epidermal barrier.

Atopic dermatitis, xerosis, and pruritus are some of the common skin reactions to hard water. Other less-well-defined effects on the skin include clogged pores and acne from surfactant residue left on the skin and altered sebum production. In addition, more surfactants or cleansers are needed to clean the skin and hair in areas with hard water because the abundant cations require a much heavier lather to dissolve.

Calcium and magnesium cations left on the skin can also form free radicals. Free radicals over time can result in collagen and elastin breakdown and in the increased prevalence of fine lines and wrinkles.

Although there is no definitive solution to geographic increases of water mineral content, water softeners have grown in popularity over the last decade and in my practice are recommended to anyone with atopic dermatitis that is resistant to treatment or is recalcitrant. These home appliances work though an ion exchange system in which a resin or organic polymer replaces the magnesium and calcium in the water with sodium or potassium cations. When all the sodium or potassium ions have been replaced in the resin, the resin is then “recharged” with a solution of sodium hydroxide (lye) or potassium hydroxide. Alternative less popular softening techniques include lime softening, chelating agents, distillation, and reverse osmosis.

Hard water and geography should be considered a possible factor when assessing patients with recalcitrant eczema, pruritus, or xerosis that cannot otherwise be reversed. Water softening treatments are a simple solution in areas where the mineral content of water is elevated or the water plays a role in clinical skin disease.


 

Dr. Lily Talakoub and Dr. Naissan O. Wesley and are cocontributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

References

United States Geological Survey Water Quality Information: Water Hardness and Alkalinity.

J Am Acad Dermatol. 1987 Jun;16(6):1263-4.

Contact Dermatitis. 1996 Dec;35(6):337-43.

Lancet. 1998 Aug 15;352(9127):527-31.

Contact Dermatitis. 1999;41(6):311-4.

Environ Res. 2004 Jan;94(1):33-7.

The words we choose to use prior to procedures can positively or negatively impact a patient’s experience during a procedure and their decision to have the procedure performed. A practical example would include using the word discomfort instead of pain to describe pain that may be associated with a procedure. The root word of discomfort is comfort, which the mind focuses on and creates less of an anxious state than pain.

Obviously, the need to provide proper and realistic expectations, as well as risks and benefits, is of utmost importance when obtaining informed consent. The words used can put a patient’s mind at ease or cause further anxiety about ideas of needles, scalpels, pain, risk of infection, and bleeding that are part of our everyday procedures.

Judith Thomas, DDS, a dentist in Virginia who is trained in clinical hypnosis, once described the power of the word but. People will often put more emphasis in their minds on what is said after the word but than on what is said before. For example, in a romantic relationship context, saying “I love you, but you drive me crazy” has a different impact than “You drive me crazy, but I love you.” The focus tends to stay on the “I love you” portion more when it is said last, after the “but.”

The same phenomenon can happen when we discuss procedures with our patients. When a medical assistant performs phlebotomy or when we as doctors are about to perform an injection, instead of saying this is going to hurt, another way to phrase it would be “In a moment you may feel something, but it doesn’t have to bother you” or “You may experience some discomfort, but it will resolve quickly.” Something I’ve said for years to patients before surgery is “You may feel a little stinging as the anesthetic goes in, after that you may feel me touching you, but nothing uncomfortable.” I guess I had been intuitively using this technique for years, without knowing the impact of the word “but.” Perhaps now that I am more mindful of it, I will be even more mindful of how I phrase these terms. We, in addition to our nurses and medical assistants, can use these techniques to enhance patient comfort and the patient’s experience.
 

According to the American Society of Clinical Hypnosis, physicians and dentists used the power of words through hypnosis as anesthesia before the first chemical general anesthetic agent, ether, was used for surgery in the 1840s, followed by chloroform. Prior to this time, British and Scottish physicians John Elliotson, James Esdaile, and James Braid performed over 3,000 procedures and surgeries with clinical hypnosis alone. Some may argue that the ancient Egyptians also used hypnosis for their well-described surgeries, as no other anesthetic has been documented. Moreover, there is evidence of “sleep temples” that the ancient Egyptians used for healing.¹

This article is not to suggest that our words should replace anesthesia. Many advances in anesthesia and pain control have been made since the time of chloroform. However, being mindful of our words can aid and assist in our surgical and aesthetic procedures where less anesthesia is used: Patients feel more comfortable, they heal faster, and overall, they have a more positive outcome and pleasant physician-patient experience.²

For patients, the skill of the doctor and the outcome of the procedure are of the utmost importance, but, especially in aesthetic dermatology, where some of our procedures are repeated or performed periodically, the positive impact of the entire experience will entrust them with your care long term.

Dr. Wesley and Dr. Talakoub are cocontributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

References

1. Mutter, C.B. (1998). History of Hypnosis. (pp. 10-12) “Hypnotic Induction and Suggestion.” Chicago: American Society of Clinical Hypnosis.

2. Burns. 2010 Aug;36(5):639-46.
 

The words we choose to use prior to procedures can positively or negatively impact a patient’s experience during a procedure and their decision to have the procedure performed. A practical example would include using the word discomfort instead of pain to describe pain that may be associated with a procedure. The root word of discomfort is comfort, which the mind focuses on and creates less of an anxious state than pain.

Obviously, the need to provide proper and realistic expectations, as well as risks and benefits, is of utmost importance when obtaining informed consent. The words used can put a patient’s mind at ease or cause further anxiety about ideas of needles, scalpels, pain, risk of infection, and bleeding that are part of our everyday procedures.

Judith Thomas, DDS, a dentist in Virginia who is trained in clinical hypnosis, once described the power of the word but. People will often put more emphasis in their minds on what is said after the word but than on what is said before. For example, in a romantic relationship context, saying “I love you, but you drive me crazy” has a different impact than “You drive me crazy, but I love you.” The focus tends to stay on the “I love you” portion more when it is said last, after the “but.”

The same phenomenon can happen when we discuss procedures with our patients. When a medical assistant performs phlebotomy or when we as doctors are about to perform an injection, instead of saying this is going to hurt, another way to phrase it would be “In a moment you may feel something, but it doesn’t have to bother you” or “You may experience some discomfort, but it will resolve quickly.” Something I’ve said for years to patients before surgery is “You may feel a little stinging as the anesthetic goes in, after that you may feel me touching you, but nothing uncomfortable.” I guess I had been intuitively using this technique for years, without knowing the impact of the word “but.” Perhaps now that I am more mindful of it, I will be even more mindful of how I phrase these terms. We, in addition to our nurses and medical assistants, can use these techniques to enhance patient comfort and the patient’s experience.
 

According to the American Society of Clinical Hypnosis, physicians and dentists used the power of words through hypnosis as anesthesia before the first chemical general anesthetic agent, ether, was used for surgery in the 1840s, followed by chloroform. Prior to this time, British and Scottish physicians John Elliotson, James Esdaile, and James Braid performed over 3,000 procedures and surgeries with clinical hypnosis alone. Some may argue that the ancient Egyptians also used hypnosis for their well-described surgeries, as no other anesthetic has been documented. Moreover, there is evidence of “sleep temples” that the ancient Egyptians used for healing.¹

This article is not to suggest that our words should replace anesthesia. Many advances in anesthesia and pain control have been made since the time of chloroform. However, being mindful of our words can aid and assist in our surgical and aesthetic procedures where less anesthesia is used: Patients feel more comfortable, they heal faster, and overall, they have a more positive outcome and pleasant physician-patient experience.²

For patients, the skill of the doctor and the outcome of the procedure are of the utmost importance, but, especially in aesthetic dermatology, where some of our procedures are repeated or performed periodically, the positive impact of the entire experience will entrust them with your care long term.

Dr. Wesley and Dr. Talakoub are cocontributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

References

1. Mutter, C.B. (1998). History of Hypnosis. (pp. 10-12) “Hypnotic Induction and Suggestion.” Chicago: American Society of Clinical Hypnosis.

2. Burns. 2010 Aug;36(5):639-46.
 

The words we choose to use prior to procedures can positively or negatively impact a patient’s experience during a procedure and their decision to have the procedure performed. A practical example would include using the word discomfort instead of pain to describe pain that may be associated with a procedure. The root word of discomfort is comfort, which the mind focuses on and creates less of an anxious state than pain.

Obviously, the need to provide proper and realistic expectations, as well as risks and benefits, is of utmost importance when obtaining informed consent. The words used can put a patient’s mind at ease or cause further anxiety about ideas of needles, scalpels, pain, risk of infection, and bleeding that are part of our everyday procedures.

Judith Thomas, DDS, a dentist in Virginia who is trained in clinical hypnosis, once described the power of the word but. People will often put more emphasis in their minds on what is said after the word but than on what is said before. For example, in a romantic relationship context, saying “I love you, but you drive me crazy” has a different impact than “You drive me crazy, but I love you.” The focus tends to stay on the “I love you” portion more when it is said last, after the “but.”

The same phenomenon can happen when we discuss procedures with our patients. When a medical assistant performs phlebotomy or when we as doctors are about to perform an injection, instead of saying this is going to hurt, another way to phrase it would be “In a moment you may feel something, but it doesn’t have to bother you” or “You may experience some discomfort, but it will resolve quickly.” Something I’ve said for years to patients before surgery is “You may feel a little stinging as the anesthetic goes in, after that you may feel me touching you, but nothing uncomfortable.” I guess I had been intuitively using this technique for years, without knowing the impact of the word “but.” Perhaps now that I am more mindful of it, I will be even more mindful of how I phrase these terms. We, in addition to our nurses and medical assistants, can use these techniques to enhance patient comfort and the patient’s experience.
 

According to the American Society of Clinical Hypnosis, physicians and dentists used the power of words through hypnosis as anesthesia before the first chemical general anesthetic agent, ether, was used for surgery in the 1840s, followed by chloroform. Prior to this time, British and Scottish physicians John Elliotson, James Esdaile, and James Braid performed over 3,000 procedures and surgeries with clinical hypnosis alone. Some may argue that the ancient Egyptians also used hypnosis for their well-described surgeries, as no other anesthetic has been documented. Moreover, there is evidence of “sleep temples” that the ancient Egyptians used for healing.¹

This article is not to suggest that our words should replace anesthesia. Many advances in anesthesia and pain control have been made since the time of chloroform. However, being mindful of our words can aid and assist in our surgical and aesthetic procedures where less anesthesia is used: Patients feel more comfortable, they heal faster, and overall, they have a more positive outcome and pleasant physician-patient experience.²

For patients, the skill of the doctor and the outcome of the procedure are of the utmost importance, but, especially in aesthetic dermatology, where some of our procedures are repeated or performed periodically, the positive impact of the entire experience will entrust them with your care long term.

Dr. Wesley and Dr. Talakoub are cocontributors to this column. Dr. Wesley practices dermatology in Beverly Hills, Calif. Dr. Talakoub is in private practice in McLean, Va. This month’s column is by Dr. Wesley. Write to them at dermnews@frontlinemedcom.com. They had no relevant disclosures.

References

1. Mutter, C.B. (1998). History of Hypnosis. (pp. 10-12) “Hypnotic Induction and Suggestion.” Chicago: American Society of Clinical Hypnosis.

2. Burns. 2010 Aug;36(5):639-46.
 

 

There are many, many, short-term and long-term consequences of sleep deprivation. The most clinically apparent ones – swollen, sunken eyes; dark circles; and pale, dehydrated skin – are obvious. However the subclinical consequences are not so obvious. Sleep deprivation affects wound healing, collagen growth, skin hydration, and skin texture. Inflammation is also higher in sleep-deprived patients, causing outbreaks of acne, eczema, psoriasis, and skin allergies.

Sleep deprivation can be caused by artificial light, shift work, sleep disturbances, and social life. Studies have shown that sleep plays a role in restoring the immune system function and that changes in the immune response triggered by high-stress states such as sleep deprivation affect collagen production. Several studies of prolonged sleep deprivation also suggest breaks in skin barrier function. Rats subjected to prolonged periods of sleep loss in a study developed ulcerative lesions on their paws and tails, and susceptibility to bacterial infection.

The reduction of sleep time affects the composition and integrity of the skin. Sleep deprivation increases glucocorticoid production. The elevation of cortisol inhibits fibroblast function and increases matrix metalloproteinases (collagenase, gelatinase). Matrix metalloproteinases accelerate collagen and elastin breakdown, which is essential to skin integrity, and hastens the aging process by increasing wrinkles, decreasing skin thickness, inhibiting growth factors, and decreasing skin elasticity.

Are there treatments to reverse these signs? Yes. Treatments to help increase skin collagen production include microneedling, radiofrequency devices, fractionated lasers, and topical agents such as retinoids. However, we cannot readily reverse the impact inflammatory processes, skin barrier dysfunction, or the disruption of the skin biome has on our skin. Beauty sleep is both necessary and irreplaceable.
 

References

1. Am J Physiol. 1993 Nov;265(5 Pt 2):R1148-54.

2. Am J Physiol Regul Integr Comp Physiol. 2000 Apr;278(4):R905-16.

3. Am J Physiol Regul Integr Comp Physiol. 2005 Feb;288(2):R374-83.

4. Am J Physiol Regul Integr Comp Physiol. 2007 Jul;293(1):R504-9.

5. Med Hypotheses. 2010 Dec;75(6):535-7.

6. Sleep. 2013 Sep 1;36(9):1355-60.

7. BMJ. 2010 Dec 14;341:c6614.

8. Brain Behav Immun. 2009 Nov;23(8):1089-95.
 

Dr. Talakoub and Dr. Wesley and are co-contributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com.

 

There are many, many, short-term and long-term consequences of sleep deprivation. The most clinically apparent ones – swollen, sunken eyes; dark circles; and pale, dehydrated skin – are obvious. However the subclinical consequences are not so obvious. Sleep deprivation affects wound healing, collagen growth, skin hydration, and skin texture. Inflammation is also higher in sleep-deprived patients, causing outbreaks of acne, eczema, psoriasis, and skin allergies.

Sleep deprivation can be caused by artificial light, shift work, sleep disturbances, and social life. Studies have shown that sleep plays a role in restoring the immune system function and that changes in the immune response triggered by high-stress states such as sleep deprivation affect collagen production. Several studies of prolonged sleep deprivation also suggest breaks in skin barrier function. Rats subjected to prolonged periods of sleep loss in a study developed ulcerative lesions on their paws and tails, and susceptibility to bacterial infection.

The reduction of sleep time affects the composition and integrity of the skin. Sleep deprivation increases glucocorticoid production. The elevation of cortisol inhibits fibroblast function and increases matrix metalloproteinases (collagenase, gelatinase). Matrix metalloproteinases accelerate collagen and elastin breakdown, which is essential to skin integrity, and hastens the aging process by increasing wrinkles, decreasing skin thickness, inhibiting growth factors, and decreasing skin elasticity.

Are there treatments to reverse these signs? Yes. Treatments to help increase skin collagen production include microneedling, radiofrequency devices, fractionated lasers, and topical agents such as retinoids. However, we cannot readily reverse the impact inflammatory processes, skin barrier dysfunction, or the disruption of the skin biome has on our skin. Beauty sleep is both necessary and irreplaceable.
 

References

1. Am J Physiol. 1993 Nov;265(5 Pt 2):R1148-54.

2. Am J Physiol Regul Integr Comp Physiol. 2000 Apr;278(4):R905-16.

3. Am J Physiol Regul Integr Comp Physiol. 2005 Feb;288(2):R374-83.

4. Am J Physiol Regul Integr Comp Physiol. 2007 Jul;293(1):R504-9.

5. Med Hypotheses. 2010 Dec;75(6):535-7.

6. Sleep. 2013 Sep 1;36(9):1355-60.

7. BMJ. 2010 Dec 14;341:c6614.

8. Brain Behav Immun. 2009 Nov;23(8):1089-95.
 

Dr. Talakoub and Dr. Wesley and are co-contributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com.

 

There are many, many, short-term and long-term consequences of sleep deprivation. The most clinically apparent ones – swollen, sunken eyes; dark circles; and pale, dehydrated skin – are obvious. However the subclinical consequences are not so obvious. Sleep deprivation affects wound healing, collagen growth, skin hydration, and skin texture. Inflammation is also higher in sleep-deprived patients, causing outbreaks of acne, eczema, psoriasis, and skin allergies.

Sleep deprivation can be caused by artificial light, shift work, sleep disturbances, and social life. Studies have shown that sleep plays a role in restoring the immune system function and that changes in the immune response triggered by high-stress states such as sleep deprivation affect collagen production. Several studies of prolonged sleep deprivation also suggest breaks in skin barrier function. Rats subjected to prolonged periods of sleep loss in a study developed ulcerative lesions on their paws and tails, and susceptibility to bacterial infection.

The reduction of sleep time affects the composition and integrity of the skin. Sleep deprivation increases glucocorticoid production. The elevation of cortisol inhibits fibroblast function and increases matrix metalloproteinases (collagenase, gelatinase). Matrix metalloproteinases accelerate collagen and elastin breakdown, which is essential to skin integrity, and hastens the aging process by increasing wrinkles, decreasing skin thickness, inhibiting growth factors, and decreasing skin elasticity.

Are there treatments to reverse these signs? Yes. Treatments to help increase skin collagen production include microneedling, radiofrequency devices, fractionated lasers, and topical agents such as retinoids. However, we cannot readily reverse the impact inflammatory processes, skin barrier dysfunction, or the disruption of the skin biome has on our skin. Beauty sleep is both necessary and irreplaceable.
 

References

1. Am J Physiol. 1993 Nov;265(5 Pt 2):R1148-54.

2. Am J Physiol Regul Integr Comp Physiol. 2000 Apr;278(4):R905-16.

3. Am J Physiol Regul Integr Comp Physiol. 2005 Feb;288(2):R374-83.

4. Am J Physiol Regul Integr Comp Physiol. 2007 Jul;293(1):R504-9.

5. Med Hypotheses. 2010 Dec;75(6):535-7.

6. Sleep. 2013 Sep 1;36(9):1355-60.

7. BMJ. 2010 Dec 14;341:c6614.

8. Brain Behav Immun. 2009 Nov;23(8):1089-95.
 

Dr. Talakoub and Dr. Wesley and are co-contributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month’s column is by Dr. Talakoub. Write to them at dermnews@frontlinemedcom.com.