SRQ Magazine | January 2017
Our first form of external defense, the skin protects, cushions and nourishes—and yet we often take our largest organ for granted, exposing our skin to harmful UV rays and damaging weather. Two practicing dermatologists talk about the importance of taking care of your skin, from the inside out. Between choosing the right sunscreen to reducing fine lines, it’s all about the dermis.
SRQ: What is the importance of keeping your skin healthy, and why should people care about it? Dr. Emily Arsenault (Arsenault Dermatology): To put it plainly: it’s deadly if you don’t. Dr. Monica Bedi (Dermatology Associates): Your skin is the largest organ of the body and the organ that is most visible to everyone. People actually see what they are concerned about and want to fix it, so they are proactive about fixing it. The things that are deadly are luckily very preventable, so if you are proactive you can catch things early. And most things can always be prevented.
In a place where skin cancer is at the top of everyone’s mind, what are some ways to prevent it, especially in a beach-centric climate? Arsenault: The best prevention is sun protection. Absolutely, hands down. Multivitamins are not a bad thing to take, but really sun protection is the best thing. Avoid the sun in the midday hours, and if you are outside working, use sun-protective clothing and hats, as well as an SPF of at least 30 to 50. You have to reapply it, and apply it thick enough and often enough. The second most important thing is examinations. Self-examinations, once a month, checking your own skin, looking for anything that is changing growing, bleeding or taking longer than a month to go away—all are early signs of skin cancers. Bedi: There is a lot of evidence now that getting your skin checked by someone who is trained makes a big difference in catching things early. Often times, people come in for something, and it’s benign, but we find something else that could be skin cancer. Even if you don’t think you have any risk factors, getting a yearly skin examination is very important. Arsenault: And to everyone lying out on the beach: don’t get burnt, don’t get tan. It’s not as cool as you think.
What is the minimum SPF you should wear and is it true that all SPFs over 50 are the same? Bedi: It’s exponential. There is definite evidence that shows if you go below 30, you aren’t getting as much protection as above 30. When you go above 30 it starts to level off, but there is evidence that with higher SPF you may be able to get away with putting on a little less. Most people don’t use the recommended amount, and it does degrade; people don’t generally put it on as often as they should. There is definitely no harm in going over 30. A lot of people are afraid of the chemicals in sunscreen—there are great options now for physical sunscreens that have the zinc and titanium dioxide, which people used to think are white, thick and messy. There are so many new physical sunscreen options that are free of all chemicals and cosmetically elegant and really easy to use. They even come in powder formation, so there really is no excuse for not wearing sunscreen.
What are some of the other big problems you see here and how can people prevent them? Arsenault: There are a huge amount of fungal infections because of the moist climate and sweating. I see a little bit of fungus on everyone. Some people aren’t even aware of it, like if it’s in one nail. Fungus lives off of dead things, especially in soil—the spores in the dirt get kicked up. With dog owners especially, the dog can have dirty paws and then dirt gets everywhere in the house. Once those spores find a nice moist, dark place, they will germinate and that is when you get a fungal infection. Most people won’t even know they have it, and it might be more unsightly than uncomfortable, but as it gets worse, it can spread to the feet causing things like athlete’s foot or ringworm. We have gotten a lot better medications for treating funguses but often times it very difficult to remove them. Bedi: In this area with the sun, we see a fair amount of rosacea too. Especially because everyone around here is active and outdoors and rosacea gets triggered by the sun. Which, again, goes back to the importance of sunscreens—the physical sunscreen has anti-inflammatory properties in it that can help with inflammation and flares of rosacea.
What aspects of lifestyle play into the health of your skin? Arsenault: Stress levels lead to a cortisol release, which can certainly make people break out, with acne and rosacea. The other thing is dairy. Dairy has been studied and can make people flare up. It’s sort of pro-inflammatory. It supports and activates inflammation, which sometimes can make acne worse. Bedi: There is some newer data showing that there is bacterial overgrowth that is linked with irritable bowel syndrome (IBS) and it’s also linked with rosacea. They’ve found that rosacea gets better with treatment for IBS. The same with gluten and dairy, et cetera—even though you might not truly have Celiac disease or be positive for the antibodies, there are a lot of people that swear that changing their diet, avoiding gluten and sugars, can definitely affect the skin and acne and rosacea and inflammation. Arsenault: Sleeping more is another thing that can help skin. But that goes back to the cortisol release that happens when you are really stressed—people get in this downward spiral, where they are not sleeping enough and they are not performing great during the day and then they are stressed out, so they aren’t very productive, so they are staying up later—it’s a vicious cycle. If people can manage their stress level by doing something such as meditation, exercise, yoga or massage, and get sleep, that only helps. Bedi: The skin is one of the organs, so anything that we know to be healthy for you in general—eating healthy, drinking a lot of water, getting enough antioxidants, avoiding processed foods, exercising—anything that you would attribute to a general overall healthy lifestyle will, in turn, help the skin. There is evidence now that things like psoriasis are associated with things like diabetes, hypertension and hypercholesterolemia. We are learning more about how everything is related.
What are your favorite products for yourself and your clients? Arsenault: I love Tretinoin. I think everyone should get a little bit, although it’s sometimes hard to find the right dosage, concentration and frequency. A lot of people say they get irritation, but when used properly and they get used to it, it’s a wonderful medication. Another thing I love is SkinMedica’s TNS Essential Serum, which has a ton of great things in it—growth factors, antioxidants and a lot of polypeptide. Bedi: I always try to focus on what I would pay for (since doctors get to try everything for free!). Right now my favorite product is NeoStrata Skin Active Dermal Replenishment. It’s very hydrating, it’s got glycolic acids, products to increase collagen and it also has a product in it called Aminophil, which has been shown to help with fine lines. It’s the only product that I use that I actually notice a difference. Otherwise I like EltaMD sunscreens, physical sunscreens, which are chemically elegant products—they have ones that have tints to them that are very nice to use daily (some people use them as makeup) and ones that you can use as a daily moisturizer with SPF. Arsenault: I’ll vote for EltaMD. They have a zinc spray that you can’t get over the counter. You know for sunscreens, you have to find one that you like so you actually use it, and the spray is very convenient, but I have always disliked them because they are a chemical sunscreen. This company, EltaMD, figured out how to aerosolize the zinc spray, so you have the best of both worlds.
When looking for new products, what ingredient should people be staying away from? Arsenault: If it comes from a major brand, I don’t think there is anything that is that unsafe. The only danger would be if your skin happens to react to it. Bedi: A lot of people that think that if something is natural it is completely fine, and I probably see the most reactions to those natural products. Arsenault: A lot of people are allergic to different plants and don’t know it.
Any closing thoughts? Arsenault: Don’t hesitate, don’t wait, don’t think an issue is going to go away. Pick up the phone. I have seen people wait four to six months to come in and it has made a huge difference in prognosis, especially with melanoma. Bedi: Skin cancer is the most common cancer and if caught early, it is completely treatable. There is no excuse in this day and age to be dying from melanoma.
About Our Participants
Dr. Emily Arsenault earned her undergraduate degree at the University of Miami, where she was invited to attend the prestigious Honors Program in Medicine. She successfully completed this rigorous program and earned her doctorate from the University of Miami School of Medicine. Dr. Arsenault finished her medical internship at the Roger Williams Medical Center in Providence, RI. She then went on to complete her training in dermatology at Boston University. Dr. Arsenault has been involved in both research and patient care. She has presented her work numerous times at national meetings for dermatologists and dermatologic surgeons. Dr. Arsenault is a fellow of the American Academy of Dermatology and has earned the distinction of being board certified in dermatology. She has been voted Best Dermatologist in the Bradenton Herald’s Peoples Choice Award for the last eight years.
Dr. Monica Bedi completed her doctorate at the University of Florida School of Medicine, her internship at Orlando Regional Medical Center and her residency at the University of South Florida College of Medicine/Moffitt Cancer Center. She founded Dermatology Associates in November of 2002. Board-certified by the American Board of Dermatology, Dr. Bedi sees patients of all ages for comprehensive dermatologic care, including skin cancer, rashes and dermatologic surgeries. In 2007, she opened Reflections Med Spa, one floor up from Dermatology Associates in order to offer the latest in non-invasive aesthetic rejuvenation. In 2008, Dermatology Associates expanded to Bradenton to better serve Manatee County residents. In addition to her practice, Dr. Bedi teaches medical students and serves on the faculty for Florida State University College of Medicine and is a volunteer attending at Lake Erie College of Osteopathic Medicine.