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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 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.

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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Interviewer: Puberty's over, but you still have acne. Is this normal? We'll find out next on The Scope.

Announcer: Questions every woman wonders about her health, body, and mind. This is, Am I Normal? On, The Scope.

Interviewer: I'm here today with Dr. Kirtly Parker Jones, she's the expert on all things woman. Dr. Jones, I have one question that's on my mind. I feel like it's on the mind of a lot of other women. My teenage years are over, I'm supposed to be done with acne, but I still have them. First of all, why is acne happening, and is it a normal thing?

Dr. Jones: It's important for the listener to understand, I'm not a dermatologist. I am a reproductive endocrinologist, so I am a ladies hormone doctor. Acne is related to hormones. So what happens is that your skin makes oils, and the little hair follicles that you have on your face make oils. But when you go through puberty, both men and women start making more male hormones which actually start to make more oils in the skin. Female hormones are also made at the same time, but the oils of the skin then can get infected a little or build up, and that's how you get acne.

So when you're young, and a young male or a young female, your hormones are high, right? Every mother knows that, every teen knows that. And not everyone gets acne, but people who are predisposed to this who have certain kinds of genes, or who have certain kinds of bacteria in their skin, can get acne. Acne's very common in adolescence. So you say, okay fine, your hormones are kind of wacky the first couple years of your periods, but then they settle down and you think "Why do I still have acne?"

Well certainly there are some people who have acne all their life, and those people should see a dermatologist if it's severe acne with big bumps that are very painful and get infected, because there's medication that can calm down your skin. Many young women know, that when they go on the pill for contraception and actually can go on the pill just for their skin, that many of the new pills can calm down the male hormones, and it can significantly improve their skin.

However for women to continue to have significant acne after the first rocking and rolling years of adolescence, they may actually have a hormone problem. Particularly women who also have irregular periods. So there is a condition called polycystic ovary syndrome, about 1 in 20 women have this. It's associated with irregular periods. Eggs that kind of get stuck in development in the ovaries and so they don't grow and ovulate, so their periods are irregular, and these little eggs, these little follicles that make the eggs make male hormones. So women with this condition often have irregular periods and persistent acne. So this may carry on, and it's worthwhile talking to your clinician about it, because in fact, there are things that can make your face better. So that's the good news.

Interviewer: If it's related to hormones, do I have to see a dermatologist then?

Dr. Jones: I think if it's something which isn't the most severe kind of what we call cystic acne, that's going to take a medication that only dermatologists prescribe. It's not uncommon, particularly during the early teenage years, when women have acne and they have irregular periods. For their moms to bring them in maybe for their very first visit to the gynecologist and say, "You know gosh she's got acne, and she has irregular periods and I had that when I was a teen and I went on pills and my face just cleared up beautifully." I say "Great. If it's the right thing for your daughter, we can do that now." So that's an appropriate choice.

Interviewer: So what I'm hearing is, your hormones are kind of out of whack during your teenage years and that's the main reason why young girls and guys get acne. But then what happens when you grow older say in your 20s or 30s, even into your 40s and 50s and you still have acne, is it still because of your hormones?

Dr. Jones: Well it's still hormones in the sense that it's still hormones that are active in your face. However, everybody makes hormones during the reproductive years and men continue to make hormones all their life. So the question is, if you have continued to may have acne after adolescence, then it's worth seeing a dermatologist or and a gynecologist, who can sometimes work together to come up with the right hormone package for you, and the right anti-acne package for you. So here's, here's the other thing. So just as hormones are a little bit wacky at the beginning of reproductive life, they get that way at the end too. And about 10% of women going through menopause get acne again.

Interviewer: Wait you get acne during menopause, is this a Dr. Kirtly Jones problem, or is this still a dermatologist problem?

Dr. Jones: So if you get acne after, when you're going through menopause, it's probably both, in a sense that for certainly menopause women are at the age when they want the dermatologist to look at their skin so they can get a skin check. But a skin check by dermatologists is often just an excuse for someone to say, "Oh I have acne, my skin's not great, but can you look at these wrinkles right here, what can I do about that?" '

In fact, the transition into the perimenopause can cause acne again, because women's hormones are a little disrupted. Again, women may actually stop making as many ovulations, they may make a little bit more male hormones. The other important thing is the dermatologist can separate what is acne from what's rosacea.

Interviewer: Okay.

Dr. Jones: So there's another condition of the skin common in women of menopausal years that can look like acne in that it's red and it's bumpy.

Interviewer: It's not.

Dr. Jones: But it's not. You don't treat it the same way. Now, for women who are going through menopause who get acne, the good news is, as they get older, the ovaries stop working entirely and in general it gets better. The other news is that some women who go on hormone replacement therapy, estrogen and progesterone or estrogen alone if they don't have a uterus, they often notice that their skin gets a little bit better because they're balancing things out a little bit.

So, A, your dermatologist can help differentiate what's acne from what's rosacea, a bumpy condition where your skin gets quite red, and it gets a lot redder when you have hot flashes. That's no fun. And they can make that difference and they can help guide you in terms of what might be the best therapy. And ladies, I've never seen a 70-year-old with acne so good news from that.

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