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October 3, 2018 by dermcare Leave a Comment

Welcome October with $100 Off Radiesse in our Chelmsford Office!

October 2, 2018 by dermcare Leave a Comment

Hormonally-Induced Acne – A Post by Dr. Michael Krathen (Dermatologist in Natick and Waltham)

September 11, 2018 by dermcare Leave a Comment

A post by Dr. Michael Krathen – Dermatologist in Natick and Waltham

As many of us are aware, acne is very common and presents in various subtypes. Hormonally induced acne, one of the more common subtypes of acne, is, unfortunately, both under-recognized and under-treated.

Generally, hormonally induced acne is characterized by deeper sometimes tender pimples occurring on the jawline, chin, forehead, and trunk of female acnepatients. Typically this acne subtype flares reliably in relationship (before, often) to one’s menstrual cycle (but not always). Menstrual cycles may be regular or irregular. Importantly, if one’s menstrual cycles are irregular, in conjunction with acne and hirsutism (excess hair growth), one should consider evaluation by an endocrinologist or gynecologist for polycystic ovarian syndrome (PCOS) or other disorder.

In my experience I divide hormonally induced acne into the following typical presentations:

1) Teens with significant acne flaring during the week before menstrual cycle

2) Young women (age 20’s-30’s), often with no history of teenage acne, with rather abrupt onset of deeper tender pimples

3) Pregnant women

4) Peri-menopausal acne (sometimes occurring several years before or after menopause as well), women in the 40’s or 50’s with tender deeper pimples generally occurring on the chin, jawline and neck.

5) Women of all ages who recently (2-3 months prior to onset of acne) switched birth control to include one of the following progesterones: norethindrone, levonorgestrel, etonorgesterel, among others.

Treatment of hormonally induced acne can be a bit of a challenge. Topical treatment generally is insufficient to improve hormonal acne, although mild hormonal acnemay be improved by clindamycin, azelaic acid, niacinamide, dapsone or other antimicrobials/anti-inflammatories. Coordinating with one’s primary care physician, dermatologist, pediatrician, and/or gynecologist is crucial, as optimizing the selection of a low-androgenicity oral contraceptive can make a huge difference in the treatment of hormonal acne. The optimal progesterones for hormonal acne include desogestrel, norgestimate, and drospirenone. Lastly, spironolactone, a diuretic often employed in the off-label treatment of hormonal acne, may be used as mono-therapy or in combination with an oral contraceptive.

The final comment to make about hormonally induced acne is regarding the use of isotretinoin. Now, I love isotretinoin as much as the next dermatologist, however one must recognize its limitations as well. Although hormonal acne will improve during an isotretinoin course of therapy, it will generally recur after the treatment has completed. As a result, before female patients commence a course of isotretinoin, it is often sensible to optimize hormonal acne treatment to determine if the isotretinoin course is actually necessary.

If the above sounds like you or someone you care about, know that effective therapies exist and the prognosis is great.

How to Treat A Sunburn – A Post from Dr. Krathen (Dermatologist in Natick and Waltham)

August 16, 2018 by dermcare Leave a Comment

A post by Dr. Michael Krathen – Dermatologist in Natick and Waltham

Alas, you didn’t heed the dermatologist’s advice to wear sun-protective clothing, seek out shade, reapply sunscreen and/or limit your exposure to prolonged direct sunlight. Or you got caught by surprise because it was not sunny out and you didn’t think the sun’s ultraviolet radiation could penetrate the clouds on the grey / overcast day (now you learned the hard way that ultraviolet A (UVA) can penetrate the clouds). And now you have a sunburn. What to do?

1. Stay cool. First recommendation is not to panic. Yes, it is true that intense sun-exposure and sunburns have been linked through *retrospective* studies to the development of certain types of skin cancer. That being said, despite the pleadings of mothers and physicians alike, many of us have experienced a sunburn in our life (yes, even yours truly) and only a fraction of us will go on to develop skin cancer in the sun-burned areas. It’s not great you developed a sunburn, but you are not destined to develop a skin cancer in the sunburned area. Just don’t do it again.

2. NSAIDS. Next step is to take non-steroidal anti-inflammatory medication, as long as you are allowed to by your primary care physician (if you have an allergy, kidney failure, a bleeding disorder, a gastric or duodenal ulcer, etc., for example, you are going to want to skip this step). Aspirin is probably best, so go ahead and take 81 to 325mg daily over the next several days. This will work to limit the skin inflammation and act as a pain-reliever. Some advocate taking high dose Vitamin-D within 1 hour of developing the sunburn, although the safety of the dose (200,000 IU x one dose!) demonstrated to help a sunburn remains unproven and is exceeding higher than the recommended daily allowance (RDA) by the US federal government.

3. Skin care. Another important step is going to be keeping the skin cool and comfortable. I recommend using aloe vera gel. Keeping this in the refrigerator in between uses will ensure that the application of the aloe vera gel is cooling and soothing to the skin. If you develop blisters, do not pop or rupture them. If the blisters do pop, keep the area moist with vaseline petroleum jelly. A helpful tip is to apply a topical steroid, such as 1% hydrocortisone, to the affected burned areas, twice daily for about 1 week in addition to the aloe vera gel. Stronger potency steroids are available by prescription from your primary care physician and/or dermatologist. Lastly, wearing loose-fitting clothing and avoiding rubbing/chafing on the affected areas will be a good idea.

4. Stay hydrated. Be mindful of water losses. Inflamed skin, especially burned and/or blistered skin, can increase water losses and dehydrate you. Make sure you are drinking plenty of water to avoid dehydration. It is important to keep in mind that if you develop blisters on a significantly large enough area of the body you will increase the risk of dehydration and causing dangerous fluid shifts. For example, if you are blistered on more than 5% of the body (the palm without the fingers is about 1% of the body surface area) you should seek out help from a medical professional.

5. Make it your last! Not to sound like a broken record, or your mother, but….don’t do it again! As Benjamin Franklin was purported to say, an ounce of prevention is worth a pound of cure.

*** The above article is not intended to provide medical advice. You should contact your dermatologist and/or primary care physician for specific advice regarding your healthcare needs.