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Interviewer: After a person has experienced major weight loss, either through lifestyle changes or something like a bariatric surgery, you may be left with a bit of excess skin that just won't seem to go away. And there are a few surgical options available to help remove that skin. Dr. Brad Rockwell is a professor of plastic surgery at University of Utah Health.

Now, Dr. Rockwell, when it comes to the excess skin from weight loss, how common is it for someone to have excess skin that just won't seem to go away?

Dr. Rockwell: Oh, virtually 100%. Unfortunately, as we get older, our skin loses some of its collagen, loses some of its elasticity, and the skin will become loose. So, even at certain ages of maturity, even if someone is not overweight, they will still have some lax skin in their abdomen. For everyone that's lost weight, virtually 100% will have some extra skin that could be improved with abdominal surgery.

Interviewer: So the surgery is an abdominoplasty, correct?

Dr. Rockwell: Correct.

Interviewer: And it's my understanding that there's a gradation of how much skin, and that kind of relates to what kind of surgery that you as a plastic surgeon would perform. Why don't you walk me through some of these treatments and kind of walk me through how they work and what a patient could expect?

Dr. Rockwell: There's the standard abdominoplasty. The non-medical term for that is tummy tuck. That's also essentially one of the main components of a Mommy Makeover. But it's just loose skin in the abdomen. In addition to the loose skin, usually the muscles beneath. If it's in a female who's had a pregnancy, the muscles will be a little loose. The skin may have some redundancy.

And the standard abdominoplasty or tummy tuck will remove skin in the lower portion of the abdomen. The skin that is higher on the abdomen is stretched to close where the skin was removed. And in addition, the six-pack muscles or rectus muscles are tightened and that will narrow the waist.

Interviewer: Okay. So it's not just the skin that you're operating on. It's also the muscles underneath?

Dr. Rockwell: Right, by tightening the underlying muscles. No muscle is cut. No muscle is thrown away. The muscle is still fully functional. There's some experimental evidence that actually shows the tone in the muscle is increased and athletic performance may be boosted a little by tightening the muscles. But the muscle is tightened. That will narrow the waist and that actually allows more skin to be removed because the inside becomes a little smaller.

Interviewer: Ah, got you. So what's the next stage of treatment?

Dr. Rockwell: So the standard abdominoplasty that we just talked about will pull the skin from the upper portion of the abdomen down lower and remove skin in the lower abdomen. Some people who have lost more weight will have a vertical skin redundancy and also a transverse skin redundancy. So the skin can be tightened by pulling it down, and the skin could also be tightened by pulling each side towards the middle of the abdomen.

The standard abdominoplasty leaves a longer scar in the lower abdomen. It goes from one hipbone to the other hipbone. The second stage does everything that a standard abdominoplasty would do, but in addition tightens skin from side to side, and that leaves an additional scar along the vertical midline of the abdomen. It goes from the bottom of the breastbone down to the pubic bone.

Interviewer: Okay. And so that's for, say, someone who has additional excess skin on the sides, love handle area, or . . .

Dr. Rockwell: It would be someone who's probably lost 50 pounds or 100 pounds. Standard abdominoplasty, maybe the people haven't lost weight. Maybe they've actually gained a little bit of weight from their younger days.

So this second stage, which is also called a fleur-de-lis, which is a French term, that will tighten side to side. And most of those people have lost probably 50 to 100 pounds.

Interviewer: And so as we go onto the last stage, this is for people who have lost a lot of weight. Tell me a little bit about this Stage 3. And I hear that it was a procedure that was developed by someone from the University of Utah?

Dr. Rockwell: Yeah. So the third stage is called a corset abdominoplasty. Dr. Alex Moya, who was a plastic surgery resident at the University of Utah in the early 2000s, now practices in Pennsylvania, and he developed this surgery.

So it incorporates everything that a standard abdominoplasty would do and everything that a fleur-de-lis abdominoplasty would do. And in addition, he pulls skin from the upper portion of the abdomen up towards the chest. The downside of it is it adds a scar right under the chest, or in women right under the bottom of the breast. But it allows even more skin to be removed compared to the other two options.

Interviewer: When it comes to deciding which surgery to do . . . I've heard you kind of discuss it depends on how much weight has been lost, how much excess skin. How much does the scarring come into that decision-making?

Dr. Rockwell: For most of these people, scarring is a secondary concern. Removing the extra skin is more of a concern. Obviously, if someone is in clothing, the scars are not visible at all.

And the majority of people who have the fleur-de-lis abdominoplasty or the corset abdominoplasty may not be on a beach exposing their abdomen. They may have little more modest clothing to cover it up, and then the scars would not be visible at all. But even if they're in that clothing and had not had surgery, the redundant skin and the rolls of extra skin would show through their clothing.

So, for most of these people, the priority is removing as much skin as possible, and the secondary concern would be the scarring.

Interviewer: So, for patients that are choosing to have this procedure done, is it an outpatient procedure? Are they in the hospital for a few days? And how long does it take to get back to your day-to-day life?

Dr. Rockwell: So just about everyone that has any of the three versions of a tummy tuck that we have discussed, it would be performed as an outpatient. The reasons to stay overnight would usually not be specifically related to the involvement of the surgery, but would depend on pre-existing medical conditions.

So if someone had lung trouble or heart trouble and their lung doctor or heart doctor might say, "You need to be monitored overnight in the hospital after that surgery," that would be the reason to stay. But most of them, it's an outpatient operation.

Interviewer: After they get home, what is the recovery time, and what are the steps of recovery, and how long will they expect to be recovering for?

Dr. Rockwell: So if someone has a desk job, they would probably be able to return to a desk job after two weeks. If they have a job that's a little more physically demanding, maybe three weeks.

In tightening the muscle, there's a six-week recovery period to resume exercise. Where the muscle is tightened, it takes six weeks for the muscle to heal where someone could attempt to do a sit up. So the long point of recovery would be six weeks to resume exercise or six weeks to lift more than 10 to 15 pounds.

Interviewer: So, for patients that might be interested in a procedure like this, what should they be looking for when it comes to choosing a good surgeon who will be able to give them the best results possible?

Dr. Rockwell: So none of these options of an abdominoplasty are small operations. They usually require between three and maybe six or seven hours in the operating room. So you want to make sure you have a qualified surgeon.

The best level of qualification that the public could find out about a surgeon is to make sure the surgeon is board certified. And for this type of surgery, make sure they're board certified by the American Board of Plastic Surgery. There are non-plastic surgeons who offer this surgery, but their background training would not be as rigorous as a board-certified plastic surgeon.

Interviewer: And I guess the last question is what are some of the positive results that people see? Are most people happy with the procedure? What can a patient expect after they're all healed up and back to their lives?

Dr. Rockwell: Yes, I think universally the patients are happy. The extra skin is gone. The satisfaction is largely patient-derived where the abdomen is closed. There's not a lot of positive reinforcement from other people because other people aren't seeing it.

But the patient himself or herself just feels much better. Their confidence increases. They find clothing will fit differently. They can buy clothing more easily because they're more a standard size. And if exercise is an option, that extra skin, extra fat is not there, and just normal everyday moving around is easier and exercise is easier.

Dr. Tarbox: Hello and welcome to "Skincast," another episode of the podcast for people who want to learn how to take the very best care of the skin they're in. My name is Michelle Tarbox. I'm an associate professor of dermatology and dermatopathology at Texas Tech University Health Sciences Center in beautiful sunny Lubbock, Texas. And joining me is . . .

Dr. Johnson: Hello, hello. This is Dr. Luke Johnson. I'm a pediatric dermatologist and a general dermatologist with the University of Utah. This is Part 3 out of three to four episodes in our series on cosmetics. We had Dr. Adam Tinklepaugh, one of our faculty at the University of Utah, here a few episodes ago. We've got Michelle back here, and we're going to spend today talking about procedures.

So, in a couple of our last episodes, we talked about sort of things you could buy over the counter, maybe stuff that you can have your doctor prescribe. And here is stuff that you can basically pay to have people do to you. And since 70% of my patients are kids, I'm going to lean on Michelle's expertise to talk about a lot of these things.

Dr. Tarbox: Well, there are a lot of different kinds of things that can be done in the office or in a procedural specialty to help improve skin health and appearance. And it starts off relatively straightforwardly and simple with an office procedure called a chemical peel.

Now, chemical peels have been around for a very long time. In fact, the idea of a chemical peel has been around for a very, very long time. There are some writings about how Cleopatra used to bathe in soured milk because it would make her skin softer and more clear-appearing. And what we know now was happening is that some of the acid degradation products of the milk were helping exfoliate the skin, some of the lactic acid and things like that that were in that preparation.

They were used medically for the first time in the 1800s by an Austrian dermatologist named Ferdinand Ritter von Hebra, who actually helped us understand the virus herpes and a lot of things about it.

But chemical peels are one of the first ways that we start to improve cosmesis in the office. A chemical peel involves the application of some kind of chemical substance, usually an acid that's a weak to mild acid that's placed on the skin, and then utilizes what we call the skin's “wound healing response”. And that plays a role in a lot of our regenerative therapies that we can do in the office.

Any time we engage the skin's wound healing response, we can improve cell turnover, we can improve collagen building, we can improve the appearance of fine lines and wrinkles, and also just pigmentation.

But it has to be done carefully because all of us have had wounding to the skin and have had it turn out in not as cosmetically-elegant a way probably as we'd like if we scraped our knee or we fell down and ground our elbow into the concrete. Many of us wear scars to remind us of that. So this kind of procedure does have to be done with care.

But when we do a chemical peel, we evenly apply typically a chemical substance over the surface of the skin we're trying to treat. That causes some level of damage or wounding to the epidermis, and then the skin's natural self-healing mechanisms are triggered, and you get replacement of some of the damaged tissue as well as new collagen synthesis and improved appearance.

Dr. Johnson: Isn't the human body amazing? And especially the skin, of course. It's always pretty awesome when we can use the body's natural procedures in order to achieve results that we're hoping for.

There are a lot of different kinds of chemical peels out there. Some of them are available over the counter, the mild ones, as you might expect. And they can be used for different things. So some of them are used for dark spots, some of them are used for fine lines and wrinkles, and then some of the more intense ones can be used for deeper lines and wrinkles.

Dr. Tarbox: And they're very useful. They have to be used by somebody who knows what they're doing, and the person has to be literate with many different skin types so that they know how oily versus dry or sensitive skin might respond to the peel, as well as different skin tones.

So certain darker skin tones might have a greater risk for hyperpigmentation, where the skin becomes darkened, or hypopigmentation, where the skin looks lighter after the chemical peel if it's done inappropriately in a patient of different skin color. So you have to be careful about selection of therapy for each patient, and each patient should be treated as an individual.

After our chemical peels, we can do something called a Photofacial. You might have heard of Photofacial. That's usually referring to an intense pulsed light treatment. Intense pulsed light is a laser-like device that creates different wavelengths of light for therapeutic targets that can range from pigment, so dark spots on the skin, to vascular, so red areas of the skin, to hair. It can actually help remove unwanted hair with the intense pulsed light.

So those are things that can be done relatively quickly in the office and don't require a huge amount of downtime for light peels. Medium peels will take a little more downtime.

Dr. Johnson: And some of these are fairly inexpensive. I know for some of these cosmetic procedures the price tag can shoot up pretty quickly. But in my experience, the chemical peels and the intense pulsed light aren't too bad.

Dr. Tarbox: And really, when it comes to medical procedures, there are a few things that play into the cost of those procedures. One of those things is the equipment it takes to do that procedure, whether that be an expensive laser, whether that be a consumable product that can only be used once per patient. That has to get factored into the cost.

So, with a peel, the cost is the peeling agent and then the supplies you use to apply the peel. And then we also have price modulation for different services based off of the complexity of the service and the requirement for aftercare.

So things that are what we call the lunchtime facial, the intense pulsed light, or something where the risk is pretty low and the follow-up care is pretty gentle, that tends not to be as expensive as something that takes more product cost, or is more complex to do in the office, or creates greater risk.

As we get to the higher percentages of chemical peels, the more aggressive chemical peels, those might go up a little bit in price. You also have to have more downtime for those more aggressive chemical peels.

Dr. Johnson: You talked about the intense pulsed light devices, a laser-like device. Let's talk about actual lasers. There's a number of them out there, and they tend to be used for different purposes.

A lot of them remove color on the skin, and there are different lasers that target different colors. So, if you've got dark brown spots, there's a laser for that. If you've got pink or red spots, there's a laser for that. And then there are also lasers that just sort of destroy the skin. But again, we can do that in a controlled way to take advantage of the skin's own rejuvenating powers in order to rejuvenate the skin.

Dr. Tarbox: And there are all kinds of lasers. There are what we call ablative lasers and non-ablative lasers. An ablative laser, if you see a picture where somebody's skin is red and it has maybe little white dots on it or it looks very irritated after a laser procedure, that's probably an ablative laser. We call them ablative because they in some way or the other go through the epidermis. So those are laser procedures that are going to require some downtime.

Our ablative lasers can include a CO2 laser. You may have heard of CO2 lasering, like Fraxel. You may have heard of Erbium YAG or Nd:YAG. Those can be ablative as well.

So these are different laser treatments that can wound through the epidermis, which can help engender that wound healing response and improve texture and appearance, but that does require some downtime. And it's a little bit more of a moment, as I like to say, as the patient experiences that laser. So it's a little more intense, but those are really good lasers that can be used to improve skin texture and appearance. The resurfacing lasers, or the ablative lasers, can be helpful in improving skin appearance in a relatively aggressive manner.

Then those ablative lasers can be used either fractionated or fully ablative where they're completely taking out every bit of the surface that they're treating on, or they can be using it in a fractionated way where it's little individual dots across the treatment area, which is going to give quicker healing time and less severe change after the laser. So that's another option.

Dr. Johnson: Poking a bunch of little holes in the skin is how I like to describe it to patients. And it's good for wrinkles. It's good for acne scars. And there's another type of device called a microneedling device that is sort of similar in concept in that it also pokes a bunch of little holes in the skin. But instead of using lasers, it uses little needles.

Dr. Tarbox: So a lot of what we do is controlled wounding of the skin where we're actually using a tool of some kind of, be that a laser, be that a microneedling device, to in a controlled way use the wound healing capacity of the skin to improve its health and appearance. So those are other ways you can handle that.

Microneedling can be used to improve acne scars. It's very good for that. It's also used to improve texture of skin on the face with fine lines and wrinkles. It improves discoloration. It also improves some of the scarring that can be left behind after an inflammatory process.

And microneedling can be used to introduce different medications to the skin. It can also be used with platelet-rich plasma or used to help improve hair growth at home. So there are lots of options with microneedling.

It can also be used with radiofrequency, where the microneedles themselves actually have radiofrequency energy that goes through them and bulk heat the tissue in another way to wound it to help improve the appearance, and texture, and turgor of the skin, meaning it gets tighter.

Dr. Johnson: Some of these microneedling devices are available over the counter. If you were to want to purchase one of those and use it, just make sure you follow the instructions, because if you don't know what you're doing, you could perhaps end up in trouble.

I think it's useful to know that in a lot of these procedures, microneedling and laser and stuff, you often need multiple treatments before you get the full results that you're hoping for. So, for example, in microneedling, it probably takes four to six total treatments to get the results that you're hoping for. So, if you're planning to do something like this, go into it with that in mind. The procedures are usually something like four to six weeks apart.

So what if it's not my face that's the problem? What if I've got spider veins or varicose veins in my legs? Can dermatology help?

Dr. Tarbox: So, for spider veins in the legs, there are lots of different ways that dermatologists can be beneficial. One of the ways that's more straightforward is our sclerotherapy treatment. So sclerotherapy actually involves the use of a medicine that is injected into the tiny vein that is broken. So we're actually injecting into the lumen of the vessel.

It's kind of like a fun skill game for dermatologists. I don't know about you, Luke, but when I'm doing sclerotherapy, I think that I understand people who play video games compulsively because of the sense of reward I feel when I actually get one of those little blood vessels cannulated. And then I see that whole mat of those broken blood vessels just blanch out as the medicine goes through them.

And what the medicine does inside the vessels is it makes the walls of those teeny tiny blood vessels that we don't use for anything . . . They're just there because we have usually a broken valve in a vein or something. Those little tiny vessel walls get sticky to themselves, so they kind of close down on themselves. And they don't have blood circulating through them anymore, so you don't see them on the surface of the skin.

And because these are basically dead-end, useless tributaries that we don't need for anything else, there's no damage to the patient by treating these. It just improves the appearance, and sometimes if there's pain associated, it improves the pain.

Dr. Johnson: Dermatologists could treat some of the little to medium type veins, I would say. If you've got a big old varicose vein, then it might need a vein specialist.

Dr. Tarbox: Yeah, vascular surgeons might be the right place for those big veins. Some dermatologists do the endovenous laser ablation. Some don't.

Dr. Johnson: What about body contouring?

Dr. Tarbox: So liposuction was actually developed by dermatologists. The person who invented liposuction was trying to find a way to treat lipomas, which are those little fatty tumors that some patients get. And so he sort of conceived of a device that was like a suction needle you could put into the lipoma and remove it that way.

We don't really use liposuction to remove lipomas, but it is used for a lot of body contouring and shaping. And it does fall within the purview of dermatology. A lot of dermatologists do liposuction. I was trained to do it when I was a resident, and it can be very useful.

Dermatologists can also use liposuction to obtain fat for fat grafting, which is a procedure that can be done to help improve areas of volume loss on the face or help improve a scar cosmesis following reconstruction.

Dr. Johnson: In recent years, there have been other devices that have been developed that have taken advantage of other technologies and other aspects of physics in order to perform this body contouring. They have names like CoolSculpting, and then there are also radiation ultrasound-type devices that can potentially perform some of these actions.

I'm not super familiar with them since I don't do a lot of cosmetics. How do you feel about these, Michelle?

Dr. Tarbox: So they don't not work. The gold standard is liposuction, where a cannula of some variety is inserted under the skin and is passed through the fat layer either mechanically through the arm motion of the operator, or ultrasonically through a sonic oscillation of the cannula itself that can withdraw the fat cells from the patient's body.

There are other things that are also using the fat's vulnerability areas. So our fat is more vulnerable to cold than other parts of our body. There's a kind of condition that often will happen with toddlers, where they get a popsicle and they just sort of let it sit on the face while they're enjoying it, called popsicle panniculitis where the fat actually dies because of the exposure to sustained cold.

And that's the premise for CoolSculpting, which I have tried to see what it was like. It is a doable procedure. It's not completely uncomfortable, but it is not pain-free. So you need to be aware going in that it's going to require a little bit of mental toughness to go through.

But CoolSculpting is based off of that popsicle panniculitis or that cold panniculitis property of fat where fat does not tolerate very low temperatures for prolonged periods of time.

When they do CoolSculpting, they apply a little gel matrix pad to the skin that is to protect the epidermis from the freezing so you don't also get frostbite of the skin. And then they use a sort of suction probe to suction part of the area of adiposity they want to treat into the treatment handle, which can then cool down and basically freeze that part of the fat that is being subjected.

And then once they remove the suction device, the fat is still frozen. When they do it on the abdomen, it makes something called a butter stick. So it's about that size. It's just frozen solid fat. Then the esthetician or the person doing the therapy for you has to massage all of that out to kind of break it apart, which does two things. It sort of mechanically agitates some of the fat cells that are already frozen, and that can break them up, which kills them. It also helps prevent there being any kind of focuses of increased damage because of temperature irregularity. So that's CoolSculpting.

Dr. Johnson: There are a number of other products out there that exist for specific purposes that have reasonable medical data to support them. So, for example, what dermatologists call submental fullness, or sort of a fatty under-chin or double chin, there's a product that you can inject that'll dissolve the fat and help it tighten up. The brand name is Kybella.

Dr. Tarbox: It's bile acid. It's just bile acid going into the skin. That also hurts. That also is a painful procedure.

Dr. Johnson: But it seems to work all right.

Dr. Tarbox: But it works. It does work.

Dr. Johnson: If you have cellulite, especially on the butt, there's a new product out there that has collagenase, which is a protein that will dissolve collagen, that has some efficacy behind it. I believe the brand name is QWO.

And then plastic surgery is, of course, its own surgical specialty and they can do all kinds of stuff to your face. Some dermatologists do some plastic surgery.

And then we didn't really talk about Botox, or more generically botulinum toxin injections, or fillers. I think we've hit those in some of our previous podcasts. I think the short answer is that Botox . . . both Michelle and I are big fans of these botulinum toxin injections, and I think you'd heard Adam Tinklepaugh talk about them too. I like them. They tend to over-perform. They're good for wrinkles, especially rather small, rather shallow ones.

And then fillers add bulk to areas where you don't have bulk. So some people prefer to have more luscious-looking lips, for example. And then other people, perhaps because of the normal aging process, have just lost some of the subcutaneous fat in certain areas of their face, and filler can replace those.

That's my quick and dirty thoughts about those, Michelle. Do you have any thoughts that are slower and cleaner?

Dr. Tarbox: I really think Botox is a great treatment for facial wrinkles. Dysport and Xeomin are other types of neurotoxins that are similar to Botox. And they also help improve the appearance of the skin as well as decreasing unwanted facial movements.

There are studies that show us that we've reviewed on our other podcast, the more scientifically-based longer podcast that we do called "Dermasphere" . . . We've discussed the fact that long-term use of Botox actually improves brow position. So it helps improve the way the face ages over time. And it helps improve also some aspects of skin texture, so you have finer poor appearance often in areas that have been treated with Botox.

The fillers, there are a lot of different fillers. There's the Restylane product line. There's the Juvederm in product line. There are HA fillers. All of these definitely are usable in a different way to fill volume deficits, to improve tissue building, and to deal with lines and expression changes that happen over the face.

They should be used by somebody who knows what they're doing, because they are not without risk if they're done incorrectly or if there is just a day of really bad luck. People can have the filler get into a blood vessel accidentally, and that can either cause some part of the tissue that's supplied by that blood vessel to die. That's called necrosis, not something that you would want to have happen to you. Or in extreme cases, it can cause blindness. So they do need to be used by somebody who knows what they're doing and has been trained to select the right location and the right filler to use. And of course, they should only be done by medical professionals in a safe and clean environment.

Dr. Johnson: And that wraps up this three- to four-part series of cosmetics, but we might talk about cosmetics more later. Who knows? There seems to be a lot to talk about.

Thanks for hanging out with us today. Thanks also to the University of Utah for supporting the podcast and to Texas Tech for lending us Michelle.

And as Michelle alluded to, we have another podcast that's scientifically nerdy. It's called "Dermasphere." It's intended for other dermatologists and the dermatologically curious. And if you consider yourself dermatologically curious, come check that out. Otherwise, stay healthy, beautiful, and handsome, and we will see you next time.

Dr. Tarbox: Hello, and welcome to "Skincast," the podcast for people who want to learn how to take the very best care of the skin they're in. My name is Dr. Michelle Tarbox. I am a professor of dermatology and dermatopathology at Texas Tech University Health Sciences Center and beautiful sunny Lubbock, Texas. And joining me is . . .

Dr. Johnson: Hey, everybody. This is Dr. Luke Johnson. I am a pediatric dermatologist and a general dermatologist with the University of Utah.

Dr. Tarbox: So today, we're going to continue our discussion on cosmetic issues and what can be done about them. And we're going to start off things focusing on a complaint that's become more of the kind of focus of the beauty industry over the past couple of years, and that is dark spots or pigment issues.

Dr. Johnson: There are a lot of different reasons why you can have a dark spot on your skin. One of the most common reasons is there was something kind of inflamed on your skin, like an acne bump, for example, and it leaves a super aggravating mark after it goes away, which is sometimes even more annoying than the acne lesion itself.

There are some other reasons that you can have dark spots on your skin. For example, just hanging out in the sun for some decades can leave you with dark spots on your skin. Those are sometimes called solar lentigines.

And then again, as we age, or as I like to say, as we accumulate wisdom, there are other sorts of dark but benign spots that can commonly appear on the skin. And people generally are concerned about them on the face and people are generally . . . they understand that they're not dangerous for the most part, but the appearance can be really irksome.

Dr. Tarbox: Yeah, it's one of the complaints that I think I hear a lot of in my practice. So here, where I practice in West Texas, we have a whole lot of sun exposure. We basically have 270-something days of sunshine every year.

Our population is a little bit more heterogeneous. So just under half of our population is comprised of patients with skin of color of one or the other skin tone. And so we do get a fair bit of complaint about skin pigmentary disorders and dyspigmentation.

Another big category is something called melasma, which can happen predominantly to women following some kind of hormonal exposure. That might be birth control pills. That might be a pregnancy. But it's a very difficult-to-treat condition where hyperpigmentation occurs on the face.

Dr. Johnson: The good news is that there are things that we can do about it. The bad news is it is kind of hard to treat. But with diligence and the right products, we can help make those dark spots fade, and perhaps even fade away completely.

Dr. Tarbox: So there is hope. There are products that can be used over-the-counter at home, and they're available to treat different irritating situations that you have with pigmentation.

One of the things we've talked about a little bit previously that's helpful for dyspigmentation of the skin are retinoids. Retinoids are topical versions of vitamin A. And they can actually affect gene expression within the skin cells and help them to withstand damage, to repair damage, or to improve cell turnover. And so retinoids are a powerful class of medications.

There are a couple of myths that go around about retinoids, so I always like to address that when I'm discussing a treatment regimen with patients. Retinoids are a medicine that are active at the level of the skin and activate gene expression in the keratinocytes. They help the skin cells to act more robustly and also to replace themselves more frequently.

Now, retinoids do not thin the skin. Some people will think that, because the skin can peel when you first start to use a retinoid. That's just a sign that the gene expression is changing in those cells because of the topically applied vitamin A product, and that it's actually helping those cells turn over more quickly, which causes the skin to peel. But the skin is not thinning.

You do have to be careful about sun exposure when you use a retinoid, and you should be careful when you're treating pigment issues in general because retinoids do thin the very outside dead layer of the skin.

So we have a layer sort of dead skin cells on the outside of our skin that helps keep us waterproof and helps improve our skin barrier. And that layer, because the turnover is happening more quickly with vitamin A products used topically, is going to be a little bit thinner and you will have less natural sun protection. It equates to about a decrease in UPF or UV protective factor of about two to three.

Dr. Johnson: We've talked about this product before. They are prescription versions of them, like tretinoin, and there are also over-the-counter versions, like Adapalene. And it looks like you've got a couple that you've listed that you like, Michelle.

Dr. Tarbox: There are a couple that I do like over-the-counter that are easy to get. So over-the-counter, you can get the Neutrogena Rapid Wrinkle Repair. That is a retinol pro 0.5% serum. It's not terribly expensive, it's well put together, easy to find.

There's another one called Paula's Choice 1% retinol ointment that is purchasable over-the-counter.

We will prescribe some often as well. There are also easy-to-find ones in the RoC line, which has a topical retinaldehyde that is helpful.

Dr. Johnson: We should probably remind our listeners, as always, that we are not sponsored or paid by anybody. So the products that we recommend, they're just ones that we like. And I know we've hit retinoids before, so let's talk about something else. Michelle, does baby got Bakuchiol?

Dr. Tarbox: So if you want to talk about Bakuchiol, Bakuchiol has everything. Just kidding. But it is a natural version of retinol. So this is from a plant called the Babchi plant, and it is a nicely active sort of natural product. It does have to be prepared properly for it to be safe for the skin. There can be some photosensitizing things in it if it is not prepared properly.

But the ones that are available over-the-counter include the Herbivore Bakuchiol serum. It's a very pretty container. The serum is easy to apply. Patients seem to like it. The active ingredient in that is Bakuchiol.

ISDIN Melantonik Recovery Night Serum is another one that has Bakuchiol, vitamin C, and melatonin in it. And then Burt's Bees Renewal Intensive Firming Serum with Bakuchiol is another alternative to retinol if you wanted to try Bakuchiol.

You should also be careful when you're using Bakuchiol or retinols because they can thin that dead layer of skin on the outside of the skin. The dead layer of skin cells, that it is our stratum corneum. So you always want to be careful with the sun.

Dr. Johnson: You mentioned that Bakuchiol is kind of like a version of a retinoid. Does that mean you don't think people should use both a retinoid and Bakuchiol?

Dr. Tarbox: That's a great question. I think you'd probably want to pick one or the other and just stick with that. Alternating those products potentially could be done properly in a well-selected patient, but it might be too irritating for everybody. So I would probably pick one and stick with it.

Dr. Johnson: Perhaps the most important thing you can do to make your dark spots go away is keep those dark spots away from further sun exposure. Sunlight really likes to fix pigment in place. So sometimes I tell patients, "All right, we're going to do these things to help make your dark spots go away, but if you go outside for one day in the sun without sunscreen, then you lose a month of the treatments that we tried." So you really have to be extra good about sun protection.

We've talked about sunscreen a lot in this podcast, so I don't think we need to hammer it too much, but if you really want to go after your dark spots, you'll put sunscreen on your face every morning regardless of what you're going to do that day, even if you're not really planning on going outside at all. And then I often recommend that people put it on over the lunch hour or something too.

So SPF 30, at least. Higher is better. And again, we've talked about this before, so I don't think we need to hit it anymore. We can move on to something called hydroquinone.

Dr. Tarbox: Yes. So hydroquinone is a product that sometimes gets a little bit of shade thrown at it, I would say, in the media. But it is actually a very helpful ingredient for dyspigmentation, and it's usually relatively easy to get in one way or another.

It helps by actually interfering with melanin production by the melanocytes, the cells in our skin that make pigment. So it actually helps to inhibit that by inhibiting an enzyme, which is kind of fun. So it's inhibiting the conversion of a precursor to melanin, our skin's pigment, into a closer end product. So it's a very useful medication.

It is safe in the concentrations that it's sold over-the-counter in the United States. It can be sold outside of the United States at a very high concentration. When it's used at that high concentration that is not approved by the FDA, it is likely in some patients to cause some dyspigmentation that can be more permanent. So you don't want to use high percentage hydroquinone that's purchased outside of the country.

Dr. Johnson: Weirdly, that can give you dark spots, even though the medicine itself is supposed to lighten dark spots. So pretty strange. When something like that happens, we say it's paradoxical. Very high potency hydroquinone that you can get across the border, for example, not really a good idea because it can leave you with dark spots, and that's exactly what you don't want.

Dr. Tarbox: Exactly. And unfortunately, the dark spots that can come from those high concentration creams that are generally not sold in the United States, those areas of dyspigmentation won't improve with anything, not lasers, not anything. So it's a sad situation when that happens, and we definitely want to avoid that for our patients.

So there are a couple of places you can get the hydroquinone-containing creams over-the-counter. One of the ones that's a nice one that a lot of patients really like is Paula's Choice Resist Triple Action Dark Spot Eraser. So that has a 7% alpha hydroxy acid along with glycolic acid and hydroquinone. So this is a product that helps to improve dyspigmentation and patients can do pretty well with it.

Another product that has been around for a long time and is not terribly expensive and is available over-the-counter is called Ambi Fade Cream. Now this kind of goes in and out sometimes of supply issues, but when it is available, it's a 2% hydroquinone along with the sunscreen.

So these are what the hydroquinone products do. There are other products that can help lighten the skin, including niacinamide. Do you use a lot of niacinamide in your practice, Luke?

Dr. Johnson: I do not, but perhaps I should.

Dr. Tarbox: I use it for a lot of things. Niacinamide is sort of a version of a B vitamin called niacin. Niacin is a very powerful B vitamin. When you take straight niacin by mouth, you can actually have quite an impressive flushing reaction. So niacinamide actually helps to protect against that, but you still get the benefits of the niacin in the treatment.

It can be used topically to help improve dyspigmentation. There are a couple of different product lines that make niacinamide-based topicals. One of the ones we've talked about a lot is the CeraVe AM and PM Lotions that have niacinamide in them. Their AM Lotion has a sunscreen. Their PM is more emollient with ceramides in it, but that's a good product for dyspigmentation.

There's also something called NIA24 that is also available over the counter and is a broad product line that has good concentration of niacinamide in it.

I use niacinamide in my practice as well for patients who make lots of skin cancer. It's a very safe B vitamin and can be taken twice daily at about 500 milligrams to help improve your skin health, decrease the risk of skin cancer that's not the melanoma type of skin cancer, and also it's good for your heart and your brain. So it's a nice thing to be around. It basically is helpful for both inflammation and dyspigmentation.

And then, of course, we like vitamin C. There are many different vitamin C products available over the counter. You do want to make sure it's made by a company that has processed it properly so that the vitamin C is actually active. Vitamin C, especially in certain forms, is more vulnerable to the light, making it deteriorate. So a lot of vitamin C serums, especially, will be in a dark bottle, either brown or blue glass. If it's in a clear container, you're probably dealing with something a little bit less active.

So Estee Lauder makes one. There's a Perfectionist Pro Rapid Brightening Serum with Ferment2 and Vitamin C that Estee Lauder makes. The Estee Lauder Perfectionist is that one.

Ferulic acid is available as a SkinCeuticals product called C E Ferulic Skin Serum. There's also something called Cellex-C Advanced-C Serum and BioBare Serum that has vitamin C in it, and those range at different price points.

But vitamin C can be very beneficial as a brightening agent to the skin, overall pigment evening. It's a very safe ingredient. You can actually use vitamin C products during the daytime and the vitamin A products at nighttime to maximize your benefit to those, or you can use the vitamin C twice a day.

Dr. Johnson: You mentioned ferulic acid for just a second. Ferulic acid helps to stabilize the vitamin C. So it's in a lot of these products too just to make sure they're working right.

Dr. Tarbox: Yeah, it's a good product add-on. It helps to make sure that that vitamin C is active and able to work.

Glutathione is another product that can be used to help improve skin pigmentation. There is a product by JJ Labs that is their Glutathione Super Skin Serum with Hyaluronic Acid in it.

So glutathione can help with the skin in a couple different ways. It's an Antioxidant, so it can neutralize and eliminate free radicals that can damage the skin and cause aging, can cause pigment changes. It is actually a very powerful antioxidant, and sometimes we even use it for medical reasons. It helps improve cell turnover, and it's just a generally healthy skin ingredient. So I do like that product. I like glutathione.

Dr. Johnson: Glycolic acid also works, and one of the ways it's used is in chemical peels. A lot of chemical peels you have to get from a doctor's office or an esthetician, but there are some that are available over the counter as well.

I give my mom glycolic acid peels, for example, that I just purchase on Amazon because they're helpful for dark spots. And if you do them over and over again, then they can cause some permanent changes.

And then they're also available in not so much chemical peels, but just sort of individual spot treatments. You've got a couple listed here, and I lean on your expertise as the more cosmetically inclined of the two of us. Glytone Dark Spot Corrector and Glytone Mild Cleanser with Glycolic Acid.

Dr. Tarbox: I do like that product. I think it's a great glycolic-acid-based moisturizer. There's also a glycolic acid product from Avene. It's a French brand. Many different companies will make an alpha-hydroxy-acid-based product for exfoliating the skin and increasing cell turnover.

Kojic acid is another option for dyspigmentation. Kojic acid works sort of similarly to hydroquinone that we discussed earlier. It sort of blocks tyrosine from forming, which is a building block that's used to make melanin. So when patients use the kojic acid, they have sort of a brightening effect on the skin. It works fairly quickly, in about two weeks, and it doesn't have that risk of the paradoxical skin darkening like the hydroquinone can.

So kojic acid can be found in the SkinCeuticals Discoloration Defense, which is a great product. La Roche-Posay has something called Mela-D Pigment Control Serum, and Neutrogena Rapid Tone Repair Dark Spot Corrector is also a great product with kojic acid.

Do you do a lot of cooking with . . . Oh, sorry. Go ahead, Luke.

Dr. Johnson: You were going to ask me if I cooked with turmeric.

Dr. Tarbox: I was going to ask you if you cook with turmeric.

Dr. Johnson: I don't, really. Maybe I should cook with more turmeric.

Dr. Tarbox: I mean, maybe you should, because it might help you have more even beautiful skin on your hands. Who knows?

So a couple different products have turmeric in it. Turmeric is a spice, but it also has anti-inflammatory properties through curcuminoids that are part of that spice. So Allpa Botanicals makes a turmeric face oil. Andalou Naturals also makes a turmeric serum that can be beneficial for skin dyspigmentation.

Some of the products made with turmeric may have an orange hue to them, and it's possible that they might cause some staining. So you want to select those products carefully.

Dr. Johnson: Does taking turmeric by mouth, like heavy turmeric-containing foods, help my dark spots?

Dr. Tarbox: It helps, in general, with total body inflammation. So it could theoretically decrease the severity of acne and might decrease the spots based off of decreasing how much acne that you have. We know that it helps with psoriasis, so . . .

Dr. Johnson: Mostly, we're talking about getting some kind of product that contains turmeric and putting it on in your skin.

Dr. Tarbox: Yeah. That is generally what we're discussing here.

Dr. Johnson: And then you've got one more product listed on our list of things that can help with dark spots, tranexamic acid.

Dr. Tarbox: I know.

Dr. Johnson: That's something that doctors can prescribe as a pill. It's not FDA-approved for the treatment of dark spots here, and it does increase the risk of blood clots a little bit. But the medical data, I think, is pretty decent for it, that it's actually pretty safe and can help.

Dr. Tarbox: Yeah. So there are products that put the tranexamic acid together with it, over-the-counter topical preparation. As Luke was saying, orally, we sometimes use this as well. We do have to be a little bit careful when we use it by mouth because there's some risk for blood clots.

But topically, there's a great product that is made by SkinCeuticals. It's called Discoloration Defense. And so it has the tranexamic acid that can decrease the occurrence of discoloration. It also has kojic acid, which is produced by a fungus. Did you know that, Luke?

Dr. Johnson: I once did, but I had forgotten. So thanks for the reminder.

Dr. Tarbox: And then also niacinamide as well as some other anti-inflammatory products. So I think that that can be very helpful for dyspigmentation. We have a whole armamentarium of things that we can do to improve discoloration. Maybe next time we can talk about what we might do in the office for that, Luke.

Dr. Johnson: I hope so. We mentioned melasma. That's sometimes referred to as the mask of pregnancy. And one of the most important things you can do if you have melasma is to stop any medicines that you take that have hormones in them. So if you take birth control pills, for example, or hormone replacement therapy, that can definitely make that stuff worse.

So I'll admit, Michelle, that your list of stuff that can help with dark spots is way longer than I thought it was going to be, though it all has some medical data behind it. I primarily see children, so that's perhaps why I'm not super familiar with a lot of these.

But with all this stuff available, give us just a sample regimen. Say we've got a listener who just has some sunspots on their skin that they don't like, and they say, "I don't really want to go to a doctor and get prescribed stuff." What would you recommend?

Dr. Tarbox: Well, of course, I would recommend at baseline all of the things that we talk to people about for a healthy skincare regimen. So getting plenty of sleep, drinking plenty of fluids, eating a nutritious diet with a rainbow of colors and lots of naturally occurring antioxidants and anti-inflammatories in those foods.

On top of that, I would make sure they add an excellent skincare regimen. Washing the skin carefully once or twice daily, at least, with a skin cleanser that agrees with their skin type. And in my personal opinion, I have a religion around sun protection almost, but I think that good regular sun protection is very, very important.

I would probably, for a normal person just kind of starting off with this, maybe have them use a vitamin C product in the morning with a sunscreen or a hydroquinone product that has sunscreen in the morning. I would make sure that they're using gentle products throughout the day to decrease any kind of blemish formation.

But I also would probably recommend Heliocare, which is that sun protection vitamin we've talked about before, that has the extract of that tropical fern in it and helps people deal with sun damage. So I like to use Heliocare as an oral supplement for patients who have dyspigmentation.

And then in their nighttime regimen, I would give them probably an alternating pattern of vitamin A medicine, either a retinol, like we discussed, by prescription or one of the over-the-counter products that I like, like the Neutrogena product. That's a very well-put-together vitamin A. Or if they wanted to try something more natural, they could use one of the Bakuchiol products like that Burt's Bees product.

I do like the alpha-hydroxy-acid-based cleansers if a patient's skin tolerates them well because they're good exfoliating agents.

And then I also would recommend that the patients have a mulberry silk pillow. The right kind of pillowcase can decrease skin breakouts and help improve skin health.

Dr. Johnson: I did not think I was going to hear about mulberries today.

Well, that's what we've got time for. Thanks for hanging out with us today, guys. Thanks, of course, to the University of Utah and to Texas Tech.

And if you really like hearing Michelle and I talk, we've got another podcast. It's called "Dermasphere." It's intended for other dermatologists and people who are like dermatologists, and we get super nerdy about dermatology. So if you consider yourself a super dermatology nerd like us, go check that out. Otherwise, we will see you next time.

Dr. Tarbox: Hello and welcome to "Skincast," the podcast for people to learn about skincare. I'm Michelle Tarbox. I'm a dermatologist in beautiful sunny Lubbock, Texas. And I'm being joined by . . .

Dr. Johnson: I'm Luke Johnson, dermatologist at the University of Utah in Salt Lake City, Utah.

Dr. Tarbox: So we're making this podcast to help educate people about how to take the very best care of their skin, and we plan to release an episode every two weeks. On this podcast, we will mention specific skincare products that we have found in our medical opinion to be very helpful and beneficial to our patients. We are not sponsored in any way or supported by any of the manufacturers of these products.

Dr. Johnson: Nope, but we are medical doctors.

Dr. Tarbox: I like it. Dermatologists are medical doctors who specialize in the care of the skin and of the hair and the nails. We're going to talk about skincare in the COVID era. So, Luke, what do you think is the most important aspect of skincare in this very unusual time we're all living through?

Dr. Johnson: Well, everybody is washing their hands a lot more because of the Coronavirus, which I think is a good idea. But a lot of people have noticed that their poor hands just get so dry and chapped afterwards. We say they have irritant contact dermatitis. Dermatitis, inflammation of the skin, because of contact with an irritant, in this case water. And it's helpful to know what to do if your poor hands get all dry and chapped.

Dr. Tarbox: And that definitely can happen in this day and age when we're all having to clean our hands very frequently. I think now more than ever it's really important to have a good skin care regimen that helps protect the integrity or the intactness of your skin, because our skin is important. It helps to protect us from the world, from bacteria, and viruses, and chemicals, and so we need to take the very best care of it. So what's your favorite moisturizer, Luke?

Dr. Johnson: Well, I love just plain old petroleum jelly. The brand name is Vaseline, but you can buy just the generic brand petroleum jelly. It's great for so many reasons. I have written a small love letter to Vaseline. It doesn't rhyme or anything. But first of all, it's super cheap, especially if you buy the generic version. You can get a big tub of it for about $3. It does a great job moisturizing the skin. So, in dermatology, we talk about transepidermal water loss, the water loss through the skin, and petroleum jelly prevents 99% of it. Also, nobody gets allergic to petroleum jelly. Love it.

Dr. Tarbox: It's easy to find, most people have access to it, and it works very well. Now, I know some people aren't always comfortable using petroleum jelly for various reasons. So, if you're one of those people, and we just can't convince you with our passionate love of Vaseline, we can . . .

Dr. Johnson: It's great.

Dr. Tarbox: It is fantastic. But we can recommend some other things as well. For some patients who don't want to use Vaseline or petroleum jelly, the nut butters may be beneficial. So shea butter can be helpful. Some of my patients have liked a product called Waxelene, which is actually derived from beeswax and is sort of a crunchy granola replacement for Vaseline or petroleum jelly. But the important thing is just to use it regularly.

Dr. Johnson: Waxelene?

Dr. Tarbox: Waxelene. I know. That's what it's called. You can find that usually in health food stores or Whole Foods markets.

Dr. Johnson: What I tell my patients often is that I know Vaseline is not for everybody. It's kind of messy and greasy. So, if you don't like it, use something you like. So just find the thickest, greasiest thing that you kind of like putting on your skin. In general, things that you have to scoop out of a jar are going to be more effective than things that squirt out of a bottle.

Dr. Tarbox: I kind of love that analogy, and that's definitely true. So you want your lotion that you're going to use to moisturize your hands in this unusual time to be more like icing and less like chocolate syrup. So when we are talking about moisturizers, if you're wanting to use something that's more of a cream, there are several over-the-counter products that I think Luke and I can agree on are very helpful to the skin and are very minimally irritating, so they don't have any excess fragrances or harsh preservatives.

Dr. Johnson: Well, if people don't buy into Vaseline, I usually don't have anything specific in mind. But the point of all this is not just to make your hands feel better, though it will. But there is a little bit of concern amongst some dermatologists that if you've developed little cracks in your skin, that could actually be a portal of entry for the Coronavirus. So the Coronavirus likes to attach to certain proteins in order to get into cells and those proteins might be present in those cracks in your hand. We call those fissures. So helping them to heal up is important, and these moisturizers will help that happen.

Dr. Tarbox: Absolutely. Now, a lot of people are using hand soap to wash their hands. Your choice of soap is also very important. Some soaps are going to really strip the natural oils from the skin, and others may be irritating because of fragrance or chemical content. So using a soap that's designed to be gentle is a good choice. What's your favorite?

Dr. Johnson: Well, as far as I can tell, the party line among dermatologists across the world is white Dove bar soap. Everyone seems to really like it.

Dr. Tarbox: I like that one. I also like . . . Vanicream makes a bar soap as well that's very hypoallergenic. Another good product is CeraVe Hydrating Cleanser. This is a cleanser that won't foam. It doesn't have the ingredient that makes soaps foam, which is usually something called sodium lauryl sulfate, which can be a little bit more dehydrating to the skin. But you don't actually need the foam to cleanse. It's just something we associate with cleanliness. So that's a great product as well and it's very gentle.

Dr. Johnson: Though I'll admit at my home I use just random generic liquid soap because my hands don't seem all that sensitive, but I do put moisturizer on them afterward.

Dr. Tarbox: It's a good idea. There's also, of course, hand sanitizer that people are using. And remember that it has to have a certain percentage of alcohol in it for it to be effective against the Coronavirus. Now, alcohol is naturally dehydrating. That's one of the ways that it actually works against enveloped viruses like the coronavirus. But that same property where it can be dehydrating can make it a little bit hard on your skin.

Dr. Johnson: And of course, in general in terms of the Coronavirus, as you'll hear everywhere, if you can avoid touching your face, that's great. In dermatology, we learned that people just touch their faces all the time for no good reason. In fact, I think I touched mine over the past two minutes like five times. So just bear in mind that there could be dirt or other nasty things on your hands that you don't want to put on your face.

Dr. Tarbox: Yeah, I think that it's something that we all have to kind of monitor our subconscious activities with and really try to pay attention to that behavior and stop it before it potentially transmits a virus we really don't want to deal with.

Dr. Johnson: Well, we mentioned moisturizers in general earlier, but this is a special spot where my favorite Vaseline really outperforms. So something nice and greasy will help it heal. Wounds heal best when they're kept moist and greasy. So I've talked to a number of patients who have said, "Won't my wound heal better if I leave it to dry?" And it's interesting because the medical community used to feel that that was the case. But something like 20 years ago, we realized it's not. If it's moist, then the new skin cells can crawl across the surface more easily. So, if you remember hearing, "You should leave your wounds dry for them to heal," that's outdated knowledge. Now, keep them greasy with Vaseline.

Dr. Tarbox: I like to think of it like trying to regrow a dead patch in a yard. So, if you think about where you've got your grass and you want it to grow back over a place where the grass has been lost for some reason or another, is it going to grow better if you have a nice moist soil that's easy for the grass to grow back through? Or is it going to grow best if you have hard, dry dirt?

Dr. Johnson: I do not have a green thumb, but I'm guessing the moist one.

Dr. Tarbox: Exactly. So I think that that's a very important thing now.

Dr. Johnson: Just don't wear a mask.

Dr. Tarbox: Ah, ba-dum.

Dr. Johnson: No, a joke. I mean, I guess if you can avoid wearing a mask because you are staying at home or whatever, that's fine. But masks are pretty important to prevent the spread of the Coronavirus, so they're a necessary evil. Avoiding other stuff that's on your face under the mask, specifically makeup. So I admit I don't wear a lot of makeup.

Dr. Tarbox: What?

Dr. Johnson: But it seems to me that if you are going to be wearing a mask anyway, then why put makeup on the part of your face that's going to be covered? It can exacerbate the problem. It also kind of messes up the masks and makes them harder to reuse if we end up needing to do that.

Dr. Tarbox: I agree. I've actually taken this whole time as a little permission to be a little less involved with my beauty routine. So while I'm paying very good attention to my skin health, and I'm trying to kind of baby that skin and be gentle with it, I'm really not using makeup hardly at all, because what's the point? It's underneath the mask and no one is going to see it. So I don't understand why I would do that anyway.

Dr. Johnson: How do you wash your mask, Michelle? Do you just throw it in the washing machine with everything else?

Dr. Tarbox: The masks that I've had, I've had some that have actually been made by people in my community, who are just wonderful, lovely volunteers. So, in my free time, I actually enjoy participating in community theater. And when this whole outbreak began, the seamstresses and costumers that are a part of the theater made this beautiful effort and sewed all of these fantastic masks out of 100% cotton and then took them to the hospitals and gave them to the doctors and nurses there. And I thought that was a wonderful thing that they did. I found that just washing them like you would wash normal clothes is a very appropriate way to take care of them.

Dr. Johnson: I like that one, and I like the Costco version of it. I don't remember what it's called. Kirkland brand Free and Clear, or something like that.

Dr. Tarbox: I found that the Tide cleansers are a little bit more harsh to the skin, and even their Tide Free and Clear still causes problems for me and some of my patients. So I tend to avoid that one.

Dr. Johnson: Sometimes it's not time to do laundry and I still want to wash my mask. So we've just washed them by hand just with a little bit of laundry detergent on our fingers, or wash them in the kitchen sink and then put them in the dish dryer to dry. That seems to work okay.

Dr. Tarbox: I think that's a great way to do that. And then you also want to make sure that if you are having to wear a mask every day, your skin can get really irritated. There are some adaptations that you can make. Some of the masks tie behind the headset instead of behind the ears. So potentially altering the style of mask you wear day to day might help protect that skin behind your ears. There are also little straps or buttons on headbands to clip behind the head that will hold the ear loops of the mask.

Dr. Johnson: And for anybody out there who's an aspiring dermatology nerd, there are medical, fancy terms for all this stuff. So the medical term for maskne is Acne Mechanica, and it can also occur with anything else that's sort of rubbing or lying on the skin. I know it's seen in military recruits who have to wear backpacks all the time, for example. And then the medical term for your poor sore earlobes after you've been wearing a mask all day is acanthoma fissuratum. There you go. We make up words to sound smarter than we are.

Dr. Tarbox: Science! So, before this outbreak, the most common place that I would see what we call maskne, what we technically call Acne Mechanica, was in my football players who were wearing chin straps and masks because they were playing football. And it being Texas, you see a lot of that.

Dr. Johnson: And the other thing I think is that's helpful to know is if you do get some of the acne stuff onto your mask, one of my favorite over-the-counter products is benzoyl peroxide. It's in a lot of acne treatment products. So look for that particular ingredient. It comes in a lot of different ways. It comes as little spot treatment pads or gels or cleansers. I kind of like it as a cleanser, because I figure you're washing your face anyway, might as well put some medicine in there, but it works fine as a spot treatment if you just have one or two spots.

Dr. Tarbox: It will bleach your towels.

Dr. Johnson: And potentially your clothing.

Dr. Tarbox: And if you have lighter colored hair, it can get your hair.

Dr. Johnson: And I want to agree with everybody that the Coronavirus sucks. I'm sick of it.

Dr. Tarbox: One hundred percent. It is not our favorite thing. If you are treating the acne, you want to be a little bit more gentle than you normally would be. So I wouldn't go for the mega acne control hot lava cream. Use the sensitive skin products right now. Take it a little bit easy on your skin.

Dr. Johnson: Yes, I'm very proud to be part of the University of Utah Department of Dermatology. It's a great place to live, Salt Lake City. It's great place to work. And if you are a super dermatology nerd and are interested in sort of some of the research behind it, Michelle and I have another podcast. It's called "Dermasphere" and it's really intended for dermatologists. Maybe you're a dermatologist. What do I know? But maybe you're just dermatologically curious. If so, you can check out "Dermasphere" on your podcast platform as well.

Dr. Tarbox: Well, we'll be releasing a new episode in two weeks and we hope to see you there. Thank you for learning with us about the skin today here at "Skincast."

Dr. Tarbox: Welcome to Skincast. This is the podcast to help you take the very best care of the skin you're in. This is Dr. Michelle Tarbox, and I'm a dermatologist at Texas Tech University Health Sciences Center in beautiful, sunny Lubbock, Texas. And joining me is . . .

Dr. Johnson: My name is Dr. Luke Johnson, and I am a dermatologist at the University of Utah.

Dr. Tarbox: Luke and I are both dermatologists. Luke, what is a dermatologist?

Dr. Johnson: A dermatologist is a physician. So we went to school for a long, long time. And then even after all of that school, we then did this training called a residency where we learned about skin from a medical standpoint. And now we're dermatologists, so we are doctors who specialize in the skin. I am a pediatric dermatologist as well, so I'm specially trained to take care of kids with skin issues, though I also see adults.

Dr. Tarbox: And I'm a general dermatologist and a dermatopathologist with a special interest in cosmetic dermatology and skin of color and pigmented skin lesions.

Dr. Johnson: Yes. Thanks to the University of Utah and to Texas Tech University Health Sciences Center for supporting us.

Dr. Tarbox: We plan to release a podcast every two weeks to help people understand how to best take care of their skin, and to share that knowledge that we acquired over that long period of education to become a dermatologist.

Dr. Johnson: I like so many things about being a dermatologist. One of the best jobs in the world. So I like that I get to see kids and adults. I like that we take care of people with acute issues, meaning they have a problem right now and they need somebody to help. And we take care of people with chronic issues as well, like skin disease, like eczema that unfortunately we can't cure, but we can keep it under control. That allows me to see patients over and over again and develop relationships.

Dr. Tarbox: I think that is absolutely one of the strengths of the field, is that it's a very broad field and we have a lot of tools to help us maximize the impact we can have on the health and wellness of people in our specific organ system, which is the skin. We like to say it's one of the most important organs in the body.

Dr. Johnson: Well, of course, if you think there's something wrong with your skin, or hair, or nails, or mucous membranes, it might be a good idea to get in touch. One of the things dermatologists focus a lot on is skin cancer. So anything on your skin that is new or changing, it's probably a good idea to see one of us. A lot of times, it's not going to be a big deal, which is great, but the times when it is a big deal, you'll definitely be happy that you came in.

Dr. Tarbox: Another thing that can sometimes cause an important impetus for somebody to come see a dermatologist is any kind of rash on the skin, especially one that's not getting better, or any rash that's particularly painful or uncomfortable because some of those can be serious. So while fortunately most rashes most people will have in their lifetime are benign and self-limited, some of them can require more specific care, and dermatologists are expert in that type of care.

Dr. Johnson: And if you don't feel like coming into the clinic . . . we're recording this at what I sure hope is the tail end of the COVID pandemic. But one of the silver linings of the pandemic world is that it's opened up the gates to a lot more telemedicine. So dermatologists have been doing a lot of teledermatology, so kind of like a Skype or FaceTime call. So if you are unable to come in because you live three hours away, or you can't take time off of work, or you don't feel safe coming in because there's still this virus running around, a lot of us are doing teledermatology, so that might be an option for you.

Dr. Tarbox: I think that's so important to emphasize right now, and I think that one of the first steps that we can take in helping our listeners take better care of their skin is helping them understand what it actually does. A little Dermatology 101 if you will. So, Luke, what are some of the functions of the skin?

Dr. Johnson: I once heard a song by John Lithgow, "I like my skin because it keeps my insides in." Of course, that's part of it. It keeps other stuff in as well. It keeps water in most importantly, and a lot of times these functions aren't particularly obvious unless they're not working right. So if your skin is not keeping water in properly, then you might have eczema, which is called atopic dermatitis, for example. Then your skin can get pretty dry and inflamed.

Dr. Tarbox: Absolutely. Whenever you have an organ system that's functioning properly, the wonderful luxury of good health is that you don't have to notice it or pay attention to it. But my goodness, when it's not functioning properly, it's hard not to think about it. I think that one of the things that we can do as dermatologists is help to get that organ system back online and back to an area where we can enjoy the rest of the things life has to offer.

Dr. Johnson: The skin does a lot of other cool stuff, too. So in addition to keeping water and the rest of your insides in, it also keeps everything else out. So you can imagine if we didn't have skin, first of all, we'd look awfully strange, and also there would be a bunch of stuff from the outside world coming into contact with parts of the body that would not do well.

Dr. Tarbox: Absolutely. That protection role is very important, and also that immune role where our skin is actually our outer wall of defense against the entire world. It is sort of like the wall in "Game of Thrones," if you will. So you have to maintain the watch, and our skin does a beautiful job of that when it's healthy.

Dr. Johnson: It also helps regulate our temperature. So human beings are pretty amazing. We can live in most environments on earth, and our skin does a decent job of keeping our temperatures about the same.

Dr. Tarbox: So what things help us to get our skin in its best shape to do these important roles? And what things actually cause some problems?

Dr. Johnson: What great questions, Michelle. I think those are the questions that we're primarily going to be dealing with over the course of this podcast. Everybody wants their skin to work right. And again, you don't really notice your skin too much unless it's not working right, and we can certainly help. But people pay a lot of attention to their skin, and presumably to other people's skin as well. So there are a lot of things out there that people use to try to make their skin healthy and keep it healthy. We're going to be talking about some strategies over the course of things here.

Dr. Tarbox: Absolutely. My nemesis. Just kidding. The sun is very important, and here in beautiful, sunny Lubbock, Texas, it is a part of life. But we do have to think about the impact the sun can have on our skin's health.

Dr. Johnson: Yes, dermatologists have a bit of a love-hate relationship with the sun, though it's probably like 90% hate, and the main reason is that it's directly responsible for quite a lot of skin cancer.

Dr. Tarbox: Skin cancer is one of the things that we take care of as dermatologists that we would like the most to prevent for our patients, because sometimes it requires us to do surgery on a person's skin. And if we can keep people from having to go through skin cancer surgery, we sure would like to. What strategies can people use to protect their skin from the sun?

Dr. Johnson: Well, there's actually a lot. You're probably thinking I'm going to say sunscreen. And you're right, I'm going to say it. Sunscreen. So sunscreen is good. It's helpful. I think we're going to have another episode where we talk in more detail about sun protection.

Dr. Tarbox: And I think that a very important factor about sunscreen is that it's comfortable for you to use. You like the smell and feel of it. I'm looking forward to that sun protection episode. I think it's going to be very helpful for our listeners.

Dr. Johnson: Well, big old hats. So wide-brimmed hats can be good. A baseball cap, that's all right. I mean, it's probably better than all right, but we like the hats that go all the way around your head. Down in beautiful, sunny, Lubbock, Texas, hopefully you have people wearing cowboy hats. There's a reason that cowboys wear cowboy hats, and it's not just because they looked cool. It's because they help prevent the sun from beating down on them so much.

Dr. Tarbox: I love to see a cowboy hat, and I always compliment my patients on them because they have that beautiful wide brim. A baseball cap will protect the front part of your forehead and some of your nose. And as we like to say down here in Texas, it is mejor que nada, better than nothing, but a broad-brimmed hat does provide better protection. Staying in the shade can be good.

Dr. Johnson: My beautiful peepers I protect with sunglasses.

Dr. Tarbox: I think sunglasses are very important. Sometimes contacts have some UV protection as well.

Dr. Johnson: I was just thinking that. I don't know how much we want to get into this. I sometimes talk to my parents of kids with eczema about this. And again, because you see problems with the skin . . . when there's a problem, that's when you appreciate the functions of the skin. A lot of people can use whatever kind of soap wherever on the body and it's not a big deal. But especially if you have a tendency toward more irritable skin, I think that it helps to be conscious of which soap you're using and how you're using it.

Dr. Tarbox: I think that's a great way to instruct parents. I think one of the problems is we all learned how to do that self-care kind of from popular media in a way. And a lot of the popular media depictions of people showering or using soap is you get sudsy all over the body and it looks very fun and it's portrayed in especially those little commercials . . . I think of the Irish Spring commercial where the guy has got the lather all over his arms and all the way up his neck and onto his face.

Dr. Johnson: Well, I think moisturizing it is helpful. Sunscreen is helpful. Again, if your skin seems to be fine without any of this stuff, then that's great. But a good moisturizer, especially on the hands because they are the ones that get washed and get exposed to soap, can keep your hands healthy and not dry and cracked. Nobody wants dry, cracked hands.

Dr. Tarbox: Maintaining appropriate hydration, eating a good varied diet full of fruits and vegetables, multiple colors of things that grow up out of the earth, or things that walk around up on them, can also help improve our skin health and decrease the problems that we experience with our skin.

Dr. Johnson: Those of you who are particularly dermatology nerds might be interested in the fact that Michelle and I actually co-host another podcast. It's really directed at dermatologists and those who are dermatologically curious. It's called "Dermasphere." So if you've got an enthusiasm for both dermatology and podcasts, you might want to check it out. We'll see you guys next time.

Dr. Gellner: Your teenager's feet may seem like they're growing so fast you have to get new shoes on a monthly basis, but teen feet can often have weird skin issues that can leave you wondering what they've been walking on. I'll talk about three common foot skin issues in teens on today's Scope.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: So your child comes to you and asks you, what's this weird bump or rash on their foot? Many people instantly think that their child has athlete's foot. First thing to ask is, is the rash mainly between the toes and at the front of the foot? Is it just in one spot? Is that all over the bottom of the foot? If it's athlete's foot, it's going to be mostly between the toes and looks like a scaly, cracking rash and it can smell bad and it really itches. Often the toenails will all start to thicken and look a funky yellow color.

Athlete's foot is caused by a fungus, but it's actually pretty easy to treat. There are several over the counter antifungal creams that you can get, and you should use the cream at least twice a day for a month. Sometimes the toenails need prescription medication, and you may need to see a podiatrist to have that treated. Many of the medications to take orally to treat adult foot fungus aren't safe for teens. Fungus loves dark, wet areas, so if your teen keeps their feet dry, that helps too, and the odor should go away as the fungus goes away too.

It's called athlete's foot because it's thought to be spread by direct contact with contaminated surfaces in locker rooms. Have your teen wear shower shoes or sandals to help prevent this.

Now, what if the rash is all over the foot and there's peeling? Well, does your child's feet sweat a lot? Does the rash start like whitish bumps that then spread to itching and peeling? That's dyshidrotic eczema, and it's treated just like any other form of eczema with steroid creams.

Sometimes just over-the-counter hydrocortisone and keeping your child's feet aired out and dry does the trick. Other times your child might need a stronger steroid cream or to see a dermatologist to help get the wet feet situation under control. Using foot odor powders in your child's shoes will help with the smell, which is caused by sweat and bacteria, and you won't get hit in the face by a nasty foot smell as much when your child takes their shoes off.

And finally, what if your child has a painful bump just on one spot on the foot that just keeps getting bigger and bigger? It doesn't really smell, but, man, it hurts. Yep, that's a plantar wart. Those are tricky to treat because, unlike warts on your fingers that grow outward like bumps, plantar warts grow deep into the foot. That's why they hurt so much. There are several over-the-counter wart removers you can try and duct tape. You'd be surprised how many things dermatologists use duct tape for. But if it gets too big, your child may need to see a dermatologist or a podiatrist for a more intense treatment, including injecting medication at the root of the wart, deep in the foot.

Whatever your child's foot skin issues are, if something seems weird or you can't get the problem to go away, make an appointment for your child's provider to check it out.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Announcer: Health information from experts, supported by research from University of Utah Health. This is thescoperadio.com.

Interviewer: How mole mapping works and how to determine if you should do it. Dr. Julia Curtis is a board certified dermatologist in the Department of Dermatology at University of Utah Health. Let's start with the very first question. Who do you recommend that gets mole mapping done? Like what patients are better than others to do that?

Dr. Curtis: So, generally, what I tell patients is if they have a lot of moles, they should get mole mapped, or if they even have a lot of funny looking moles to them. They might not have a ton, but at the same time, they still might have enough that they are curious about them and they're hard to track, if they're hard to know if they're new or changing.

Interviewer: Let's talk about the benefits of having this procedure done because there are a lot of them. First and foremost, it can save lives.

Dr. Curtis: Yes, it can. It can save lives in the way that we can find melanoma earlier and thinner when it is the absolute most survivable.

Interviewer: And what are some of the other benefits as well?

Dr. Curtis: So you can catch new moles that could be just benign, not changing, that are not melanoma, which are important to know about. You can also tell if your moles are going away. As you get older some of your moles do go away and it can track that. So it gives you peace of mind. And it can reduce the number of biopsies as well on patients.

Interviewer: So that's a good thing, right? It's a lot better to have a picture taken then actually need to do biopsies . . .

Dr. Curtis: Yes.

Interviewer: . . . and less expensive too I'd imagine.

Dr. Curtis: Exactly.

Interviewer: Yeah, to have that kind of testing done. And I would imagine does it prevent like mistreatment as well?

Dr. Curtis: So it can in the sense that you do meet some patients who've had a dermatologist or primary care take a lot of their moles off and it can prevent that.

Interviewer: When you come in to have the procedure done, how exactly does it work?

Dr. Curtis: So first you meet with me and we go over your moles and talk about mole mapping, and then you go to our room, which is a very private room with one other person, and there is a camera on an automated track, and the camera goes up and down and you just stand in front of it for a front-side side and back and the attendant stands behind a big flash panel. So you feel like there is privacy there.

Interviewer: Yeah, because I would imagine some people are a little . . . first of all, they probably picture somebody with old-school Nikon camera snapping away, right? It's not that at all.

Dr. Curtis: It is not that anymore.

Interviewer: Yeah.

Dr. Curtis: And it is . . . it can be intimidating to stand there naked, but again we . . . you know, we protect patients' modesty. If they feel more comfortable leaving their underwear on, they can do that.

Interviewer: And you try to work around.

Dr. Curtis: And try to work around, exactly.

Interviewer: Yeah, exactly. And how often then, after you get that initial mapping, do you need to remap?

Dr. Curtis: So, generally, we don't remap patients because we don't want a moving baseline. So we want to establish just one baseline going forward in time and so that you don't have to be re-imaged. Occasionally, we may decide that there are so many different moles now or new moles that it would benefit the patient.

Interviewer: All right, and what do we know about mole mapping's effectiveness and its accuracy? Does it really make a difference?

Dr. Curtis: It does. So we've published research showing that it catches melanoma thinner and earlier at a much higher survival rate. For example, melanoma caught early has about a 98%, 99% survival rate of 5 years, whereas if you catch it a little bit later, that rate plummets to 60% at times.

Interviewer: And from a physician's standpoint that's pretty significant.

Dr. Curtis: Very significant.

Interviewer: Very significant but worth the effort.

Dr. Curtis: Definitely worth the effort . . .

Interviewer: And the time.

Dr. Curtis: . . . and the time.

Interviewer: Yeah, and maybe . . .

Dr. Curtis: And some embarrassment, maybe.

Interviewer: Yeah. A little bit embarrassment. Sure, yeah. So is this a procedure that can be done most anywhere, or is it just a select few places?

Dr. Curtis: So it's just a select few places to have this integrated automated system. So we have it at Huntsman and at our Murray location. And I don't know of any other providers in the Salt Lake basin that are doing it.

Interviewer: Got you. And in the region too, if somebody was in a smaller community, they would want to come here and get this . . .

Dr. Curtis: Correct. I have patients come down from Wyoming and Idaho and even Nevada.

Interviewer: And then a great thing about that is they have that map and they can return to their hometown and consult with their own dermatologists at that point. They don't have to keep coming here.

Dr. Curtis: Correct. We give them a password encrypted flash drive so that they can take it to their provider, whether it'd be a dermatologist or their primary care.

Interviewer: Yeah, that's great that's it's password encrypted because I would imagine some people will be a little anxious about having those type of photos available to everybody.

Dr. Curtis: Exactly.

Interviewer: And even as part of the medical record you don't put them in the medical record. But I don't know.

Dr. Curtis: Correct, they're not in the medical record. They're on a separate encrypted drive that only a few people have access to.

Interviewer: Got you. Is there anything else that a patient would want to know about this mole mapping procedure?

Dr. Curtis: It's short, it's painless, and it saves your lives.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Interviewer: A long hot shower is one of life's simple little pleasures. But could your shower actually be causing your skin to become dry and itchy? Dr. Emily McKenzie is a dermatologist. Please say it isn't so.

Dr. McKenzie: Yes. So many people like to take long hot showers as a nice way to relax at the end of the day or to wake themselves up in the morning. Unfortunately, the hotter the water it is, the more oil and moisture is removed from your skin. The longer you're in the shower, the more that this process is prolonged. So taking shorter lukewarm showers is actually more protective for your skin. Additionally, using milder, less harsh soaps can help your skin to retain a lot of its natural moisture. So as hard as it is to give up those hot showers, taking shorter lukewarm ones is the best thing you can do to keep your skin happy.

updated: February 10, 2021
originally published: April 30, 2019

Interviewer: Skin infections, when is it the time to go to the ER? We'll talk about that next on The Scope.

Announcer: This is From the Frontlines with emergency room physician Dr. Troy Madsen on The Scope.

Interviewer: So here's the situation. You've got this redness on your arm. It could be from maybe an ingrown, a cut, maybe an ingrown toe nail. Maybe it's just redness on your arm that starts spreading and taking up more and more of your skin. It could be an infection. Should you go to the ER for that? Dr. Troy Madsen is an emergency room physician at University of Utah Health. First of all, I think it's important to say that infections can be really serious. Like, we tend to forget how bad they can be because we've gotten really good at dealing with them.

Dr. Madsen: That's exactly right. Infections are one of these things where you may look down, again, at your arm or your leg, you see some area of redness, you think, "Oh, it's just going to get better." But we often sort of take for granted that, yes, infections are easy to treat, they don't kill people. But we certainly see cases in the ER of very serious infections. Oftentimes people who have put off going to the ER for whatever reason, where that infection grows, it's a very serious infection, it then leads to sepsis or an infection into the blood stream, and sometimes can be a life-threatening thing.

Interviewer: So that type of an infection, would it ever get better just on its own? Like, if I see that red area on my arm and it starts to spread, and I'm like, "Well, I really don't want to go to the ER. Maybe it'll just get better." Will it get better without treatment? Will my immune system fight it off?

Dr. Madsen: Usually not. The cases we see. . .

Interviewer: Really?

Dr. Madsen: Yes. It's one of these things where once you get that bacterial infection that settles in there, say, in the arm or in the leg or wherever it is and for whatever reason, oftentimes I don't have a great answer for why this infection started. It's typically not going to get better without antibiotics. The exception to that might be if you have a little abscess, so like a little pocket of infection and maybe it starts to drain, that sort of thing once it drains may get better. But if that infection then spreads to the skin around that abscess where you start to get a lot more redness, it's expanding, you see red streaks tracking up your arm, that can be a very serious thing and without at least starting some sort of antibiotic, whether it's oral antibiotics or, in more serious cases, IV antibiotics, it's really not going to get better.

Interviewer: ER or urgent care?

Dr. Madsen: If it's the sort of thing where it's just a local area of redness, maybe not bigger than, say, 3 or 4 inches long, you're probably okay to go to an urgent care. They'll prescribe some antibiotics. But if you're having fevers with it, chills, you see streaks tracking up your arm, I would recommend going to the ER because those are cases where you may need some blood work, you may even need IV antibiotics and admission to the hospital.

Interviewer: Got you. So, if you have an infection and it continues to get bigger and bigger, it's not going to get better on its own, you do need to go talk to somebody, otherwise it could be bad news.

Dr. Madsen: Exactly. Another thing to watch for with infection, there are cases you may have heard of flesh-eating bacteria. It's a scary sounding thing. But there are cases of really serious infections that you need to get to an ER as quickly as possible. And these are infections usually in people who may have some immune system problems, maybe they have diabetes, maybe they have cancer where they're on treatment for that.

But these are infections where it's a very, very rapidly spreading infection, and you feel sick, and you may even push on that area of infection and it feels kind of crunchy, kind of a weird sort of feeling to it like there's air under the skin. This is something that's called necrotizing fasciitis, and this is something where you need to get to an ER as quickly as possible, as that it's the sort of thing that often requires surgery. It's rare, but we see it, something that's worth mentioning with a rapidly spreading infection. So infections, something that may seem simple, but it's not something to mess around with.

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Dr. Gellner: You look at your child's hand and see a bump and you know it is a wart. Do you rush to the doctor or can you treat it at home?

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: So warts are raised, round, rough surface growths on the skin. They occur most often on the hands and they're not painful unless they're on the bottom of the foot and that's called a plantar wart. They can also hurt if you child keeps picking at them and they get infected. Unlike a callus, a wart has brown dots in it and has a clear boundary with normal skin around it.

Warts are caused by papillomavirus and are harmless actually. Most warts disappear without treatment in two or three years and with treatment they're gone in two to three months. So how can you take care of these unsightly warts?

First it sounds strange but cover the wart with duct tape. I know, doesn't it just seem like duct tape fixes everything? You should:

• Cover the wart with a small piece of duct tape just like you would use a band-aid. Warts deprived of air and sun exposure sometimes die without the need for topical treatments.
• Remove the tape once a week, wash the skin, and rub off any dead wart tissue. After it has dried thoroughly overnight, re-apply the duct tape.

The tape treatment may be needed for eight weeks. So find some cool duct tape that your child will like wearing.

To get faster results with duct tape, use an over-the-counter wart medicine. The best ones contain 17% salicylic acid.

• Put the medicine on the wart once a day enough to cover the entire wart. Be aware, do this in a well ventilated area, because the acid stinks.
• Cover the wart with duct tape after you put the medicine on the wart and the medicine has dried.
• Make sure you don't get any of this medicine near the eyes or the mouth. The medicine will turn the top of the wart into dead skin and it will all turn white.
• Once or twice a week, remove the dead wart material by rubbing the dead skin off with a pumice stone or washcloth. The dead wart will be softer and easier to remove if you soak the area first in warm water for 10 minutes.

Warts are contagious but mainly to the child that has the warts. They aren't very contagious to other people.

If your child chews or sucks on the wart, cover the area with duct tape and change it as often as necessary. Encourage your child to give up this habit, because chewing on the warts can cause warts on the lips and or the face. If that happens, your child needs a trip to a dermatologist.

Warts can look ugly but we pretty much all have them at some point in our lives. By knowing how to treat them fast and right away, you can make these ugly bumps go away quickly.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: September 14, 2018
originally published: May 13, 2016

Interviewer: Mole crowdsourcing: it's an innovative way to discover and identify melanoma and that's coming up next on the scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs, The Science and Research Show is on The Scope.

Interviewer: You know, it sounds a little gross. Take a picture of what you suspect to be a cancerous mole and then post it to the Internet for others to see, but it turns out that might be a really effective way to screen for melanoma. Jake Jensen is from the Department of Communication at University of Utah and he won a $2.2 million grant, part of the 2015 and NIH New Innovator Grant to look at that. So first of all, is that an accurate way to screen for skin cancers, take a picture and have non-trained people look at it?

Jake: Well, a dermatologist might quibble with the phrasing of that. Whether it's a form of screening or not, we could debate. What it is is it's a really effective way to potentially move people to go to a dermatologist.

Interviewer: So let's talk about the way things are and why that's not necessarily getting the job done and the way that you hope your research points to the way things could be.

Jake: What happens right now? Well, right now, we say to people, "You should engage in monthly skin self-exams where you look at your body and look for strange moles, strange growths. And when you see them, you should make note of them and you should go into a dermatologist for a clinical skin examination." That's our basic game plan.

There are lots of problems with that game plan. The first problem with a game plan is skin self-exam is not very effective. People are very bad at finding odd-looking lesions and moles on their body. And so I spent the better part of a decade doing research on skin self-examination, trying to improve the technique. And study after study, people were horrible at it. No matter what we did, they were horrible. The only consistency in the research was no matter what we did, people were horrible at skin self-examination and that's what other researchers were finding as well.

We were all frustrated in one day, in my frustration, I walked into one of my colleague's offices because he has a wonderful couch in his office. And I flop myself down on his couch and I said, "I'm so tired of skin self-examination research. No matter what I do, it won't work. There is no solution." And we talked about it for a while as I vented and eventually, he said something that forever changed the way I thought about this. He said . . . keep in mind, he's not a health researcher. He's somebody who studies new media so he was a good person to vent to in that he was like, "I don't know what you're talking about, but I know you're angry." And he said, "Well, is it that individuals are bad at skin self-exam or is it that groups are bad?" And I thought, "Individuals are bad so groups are bad. So I don't understand the question."

Interviewer: Yeah. Because if one person's bad, how are 20 of those people any better?

Jake: I said, "I don't understand the question." He goes, "Well, there's this thing called collective effort that says sometimes a group is good at something when an individual is not. You can take a group of individuals who are bad at a task, but as a group, the group somehow can be used and mobilized to be good at a task." And I said, "Okay. Rather than, 'Are individuals good,' here's what I want to ask." I took a rock or a curve. It's a type of statistical analysis. I said, "Is there a rock curve that fits to this data?"

And there was, at the group level. And here's what it looks like, for most moles that people look at, they're not suspicious. Take a photo of any mole on your body or any mole that you encounter. Take any mole imagery and you show it to people, generally, they say, "That looks fine." However, when more than 19% of people say a mole looks suspicious, now we're in a different world. If you use that as a cutoff, you can find 90% of melanomas because there's something there that the group picks up on. Here's why I kept missing it: because when you're thinking about the individual level of ability, you're saying, "Well, I want individuals to find it 90% of the time." But individuals can't do that. Groups can when we use a cutoff and we say, "Well, if it's more than 19% of the group that's concerned, let's use that as an indicator."

Huge implications for that. It doesn't matter whether you train people. In a sense, the best group is a group where you say, "Just tell us whether you think that's a weird image or not. Is that a weird mole? Just yes or no." Sometimes, people would say to me, "Can we have laypeople doing this?" It's risk factor. They're not trained. When it comes to laypeople, I see no evidence that training them makes them better at this intuitive, sort of "Is it weird or not" because I'm only going to look at them on the group level. I'm not going to look at them as individuals. So I just want to know if the herd finds it weird. And the answer is when they do, we kind of find melanoma.

Interviewer: Let's go back to the original problem. The original problem is individuals aren't good at self-screening. So they see a mole and maybe they might not think it's a problem. Is that the problem? Or is the problem that they don't do anything about it?

Jake: Yeah. Well, chicken or the egg in some ways.

Interviewer: I guess what I'm asking is will this solve the problem that you've laid out?

Jake: So here's what we want to do. I want to tell a real quick story because it'll help you to understand where we want to go with this. Imagine there's a farmer and the famer's name is Joe. Joe is out in the field and Joe sees that he has a weird mole on his arm. He comes home that night and he tells his wife, Martha, "Hey, I've got this weird growth on my arm." Martha says, "You need to go in to a dermatologist."

Joe is reluctant to go to the doctor for any reason and Martha knows this. So she rails on him for the rest of the night. But Joe, "Eh, it's harvest." He'll go later. Eighteen months pass by before Joe eventually goes in. By the time he goes in, he has late-stage melanoma. There's very little they can do for it at that point in time. Joe passes away within the next few months.

I'll give you an alternative ending to that story. Everything is the same about the story, except this: when Joe comes in from the field and shows Martha the mole, Martha pulls out her phone. She snaps a photo of the mole. She doesn't even bother arguing with Joe because she knows Joe will not listen. The next morning at breakfast, Martha slides the phone across the table and says, "Ten thousand people have looked at your mole and 47% of them think it looks weird." And that's such a high score that it was flagged in the tele-dermatology system and a dermatologist who does rural rounds, who will be within 40 minutes of us next week, wants to see you at 9:00AM next Tuesday because she's looked at the mole and she is suspicious as well."

Joe goes in next Tuesday. It's pre-cancerous. The dermatologist chops it off. Joe lives. Now, that cell phone system I just described is what we're trying to build.

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