If you itch, read this

If you haven't noticed, the leaves are changing, there is a nip in the air, and the smells of fall have arrived. Only a quick glance at the calendar betrays the obvious conclusion that Autumn has begun. Not to brag, but I told many of my patients in July that fall would come a month early this year. I knew it because my allergy patients were suffering and my eczema patients were scratching. These diseases are known as the atopic diathesis and they include eczema, hay fever, and asthma. Eczema and asthma are not allergic diseases though they can be made worse with allergic stimulants and hay fever is mostly a reaction to ragweed and mold. So the question is: why is fall early and why are our body reactions so predictable? In fact our body reactions predict the onset of each new season.
Well, I don't know why our bodies have a diurnal rhythm or why they have a lunar rhythm (don't believe me? Work a night in an emergency room when there is a full moon.) Fevers rise at night, itching and pain worsen at night, many diseases worsen with the seasons. More specific to these ailments, what is going on and what shall we do about it?
What is going on: The body releases mediators, chemicals which cause metabolic reactions in the body, on a relatively fixed schedule. And that is usually spring and fall. We make this worse by polluting the air and more specifically by turning on dry heat in our homes. Dry heat not only causes more water loss from the skin which in itself itches, it also probably causes more release of those annoying mediators. (These mediators also have a good side protecting us from infection, disease, cancer, and so on.) Our reaction is to feel an itching sensation and to scratch. Scratching injures the skin and causes more itch and eczema and so the vicious cycle is perpetuated.
What to do about it is another thing. Preventing water loss is very important. Moisturizers are the buzz words in cosmeceuticals, but in fact the primary problem is water loss and not dry skin per say. Moisturizers work by reducing water loss and in some cases by adding moisture to the skin. Once fall hits, and especially after the furnace is turned on, moisturizers are essential every day. There is a new study in children that indicates that moisturizers do not have to be applied after a shower or a bath but I prefer it because of convenience and the added water the shower brings.
The second remedy is antihistamines. Unfortunately, while there are many over the counter antihistamines for hay fever, the are none that work well in the skin that are sold without a prescription. For this, my recommendation is to see a dermatologist well versed in antihistamine treatment of eczema.
One last point: stronger is not better. More salt in a salty dish does not taste better. Stronger steroid creams may damage skin and the adrenal gland and may not make you better. Treating eczema with one thing, like a cream, is like making a quiche with one ingredient.
This year, with an early fall and probably early winter, prevention is 90% of the cure. Use a portable humidifier in the bedroom and topical moisturizers daily.

Lastly, in the spirit of the demagoguery of Sara Palin let me give a few explanations the conservative right may offer for the onset of itch: the health care debate makes you itch and then the death panels will finish you off; immigration to this country is ruining our schools and must be stopped retroactively; lastly, the godless culture in the world is making everyone itch. Reasons from the fanatical left may include: Sara and the NRA are contaminating our water supply with chemicals that make us itch; insisting that Americans work for a living makes people anxious; and lastly,the possibility of giving up the right to frivolous lawsuits and limiting punitive damages makes Americans even more anxious and itchy.

Watch Out: Your Dermatoporosis May Be Showing

As a youngster I enjoyed getting under my classmates skin (nothing has changed). I would taunt "Your epidermis is showing ...". I encouraged my son to do the same and when his classmates found epidermis referred to the skin I encouraged him to taunt "Your proboscis is showing ..."
I was at the European Academy of Dermatology meeting in Munich this summer and there I learned your dermatoporosis may be showing. I mean you, yes you. With so much self-indulgence today I should think this may be a source of considerable discomfort to a great many people.
Dermatoporosis refers to a particular aging of skin which results in thinning, wrinkling, and bruising. You may have observed it in your parents, but are you ready for your own skin? New research reveals that what has been assumed to be a result of dry skin, dehydration, or hormone depletion is probably a result of hyaluronic acid enzymes that destroy hyaluronic acid, the water retaining molecules of collagen in the skin. In other words a reduction of hyaluronic acid in the skin thins the dermis so that it can no longer protect itself and causes the skin to waste away.
To be sure, many of the treatments for aging skin which have empirically been shown to be beneficial, actually increase hyaluronic acid in the skin. For instance, Photodynamic Therapy which fights skin cancer and sun damage appears to cause oxidative changes that release hyaluronic acid fragments that stimulate a molecule, CD44, which restores hyaluronic acid. Retinoids, fat transfer, hormones, and some nutrients may do the same. The ultimate irony is that hyaluronic acid fillers, Restylane and Juvederm, which are so popular for treating wrinkles and restoring youthful faces may not just be a cosmetic enhancement but a biologic rejuvenation as well.
The good and the bad: Many of the advances in medicine have come as a result of serendipity. The discovery of penicillin, the use of antihistamines, and the anti-inflammatory effects of some antibiotics are a few examples. Therefore it is not surprising that a cosmetic application of a naturally occurring product may unwittingly be a medical solution to a vexatious process: old skin. The problem is that with so much conjecture every self-seeking practitioner, whether physician or other, can lay claim to unfounded and ridiculous cures that have no basis in fact. Caveat emptor: Let the buyer beware!

When a 50 Year Old Doctor Calls You Mommy, Watch Out

Type in "mommy makeover" in google. There you will find a list of cosmetic surgeons who propose to restore the body of any newly blessed mother from the ravages of her pregnancy.
I don't know about you but I find the term "mommy makeover" degrading. How does an adult male/female physician refer to a patient as mommy and then presume to treat the patient with respect. For that matter how does a mature and respectful physician indicate to a patient that he respects her intelligence when he uses baby words like tummy , boobs and all its acronyms, belly button ,and so on. Medicine and physicians, and most prominently cosmetic physicians, have a long history of misogyny and chauvinism and I am not proud to report that the tradition of looking down on women is now being perpetuated by female physicians.
For some time I have posed the question to patients: if your doctor will lie to your insurance company about a procedure he performed in order to have them pay your bill, do you think your physician would have any qualms about lying to you? Now I ask the question, if your physician speaks to you in a condescending manner which communicates his arrogance and how little respect he has for you, do you think that physician will respect your best interests and provide appropriate care? To wit, I saw a lovely woman last week who saw another cosmetic dermatologist the week before for treatment of a small scar. The dermatologist, unasked, told her that her face was sagging, her skin was a mess, and she needed $2000.00 of fillers and botox to correct a problem this patient had never perceived existed. When she told me of her discomfort I analyzed her face. She is 40 years old, African American, round faced, perfect color and texture of skin, and by any one's standards quite beautiful. Her previous doctor is a charlatan at best.
It is appropriate for women as consumers to make some demands on the medical profession, and the first demand starts with respect.
This is my 100th blog. When I began 3 years ago I had no idea what it would take for me to write a blog, whether I would keep it up, and if anyone besides myself and my wife would read it. To those of you who read this blog may I offer my sincere thanks. To those who have not cancelled my e-mails, I am grateful. To those with whom I have been able to share some opinions and perhaps struck a mutual cord I promise not to stop. I have 2 new offers to write for different websites and I will tell you of these when they launch. To everyone, I am very grateful for this life and feel most blessed that you allow me into your hearts and minds.
Edward Lack MD

World Health Organization: Tanning Beds Cause Cancer

from WebMD
The World Health Organization’s International Agency for Research on Cancer (IARC) announced today that it has moved UV tanning beds to its highest cancer risk category -- "carcinogenic to humans."
Prior to the move, the group had classified sun lamp and tanning bed use as "probably carcinogenic to humans."
In an interview with WebMD, the IARC’s Vincent Cogliano, PhD, called the scientific evidence linking indoor tanning to the deadly skin cancer melanoma “sufficient and compelling.”
A dramatic rise in melanoma, especially among young women, has been seen in recent years.
Cogliano said studies conducted over the past decade provide an “an abundance of evidence” that tanning bed use has played a role in this rise, along with direct sun exposure.
“People mistakenly see a tan as a sign of health when it is actually a sign of damage to the skin,” he says.
Now there are several issues here. The first is that no one can argue tanning beds are safe. End of story!
The second is that we still have the issue of some males and females who claim they look better with a tan. I don't understand. To wit: People of color in Africa and India have a caste system that ranks people as more prestigious from light to dark complexions. I know that in my parents' generation those who advocated racial equality and a color blind attitude rately lived on the same block with a person of color. I know that patients see me for treatments to make them look more youthful and yet they know that a sun tan ages their face and body. (Is anyone still arguing against me that long hair makes a woman look older?)
And yet, and yet, my wife says she wants sun tanned legs. In fact, on our last trip to Sweden she got sun tanned legs, and a sun tanned face, and a sun tanned body. OK. Her rebuttal is I am also tanned. Yet my genetics is Mediteranean and while I do monitor the amount of sun I aborb and always wear a hat and a shirt, I darken quickly. That is my Semitic heritage I cry in my defense.
And so the jury is no longer out. Sun tans and sun tan parlors cause malignant melanoma. Malignant melanoma kills people. Tanned skin looks old.