Dermbusters

In this episode of Dermbusters, host Nicholas Brownstone, MD, chats with acne and rosacea expert Emmy Graber, MD, MBA, about some common misperceptions they often hear from their patients. Dr Graber shares some tips on counseling patients on 2 topics: how diet impacts acne and advising patients on isotretinoin to wait 6 to 12 months before getting cosmetic procedures. Myth 1: Fried and fatty foods cause acne. Dr Graber addresses the widespread belief among patients that fried and fatty foods can induce acne. She acknowledges the challenges of studying diet’s impact on acne but shares a few tips on counseling patients based on published data. Tips for counseling your patients: Explain to patients that while some studies suggest a correlation between high-glycemic foods and acne for some individuals, the association is not universal Emphasize the role of dairy products, particularly skim milk products, in exacerbating acne for some patients For patients who can identify specific dietary triggers, give them the option of avoiding that food Emphasize the uniqueness of individual responses to dietary triggers rather than making blanket statements Myth 2: Patients must wait at least 6 months following the use of isotretinoin before having any cosmetic or surgical procedures. Dr Brownstone and Dr Graber then discuss advising patients on isotretinoin on the often-recommended waiting period before undergoing any cosmetic or surgical procedures. Dr Graber challenges the traditional notion of waiting 6 to 12 months, relating a few discussion points to share with patients. Tips for counseling your patients: Cite a systematic review of over 32 studies and 1400 procedures1 that found no evidence supporting the need for a prolonged delay for cosmetic procedures following isotretinoin use Advise patients that procedures like visible light lasers, hair removal, superficial chemical peels, and fractional and ablative lasers are safe while on isotretinoin Counsel patients to follow the waiting period and delay more intense procedures like nonfractional lasers, deep dermabrasions, and deep chemical peels until there is more data available to support the safety of such procedures while on isotretinoin Mention potential benefits of pulsed dye laser treatments for acne for patients concurrently on isotretinoin, noting not only safety but potentially improved outcomes Tune in to the episode to hear the full details on Dr Graber’s informed approach to counseling patients that embraces evidence-based practices to optimize care. Reference Spring LK, Krakowski AC, Alam M, et al. Isotretinoin and timing of procedural interventions: a systematic review with consensus recommendations. JAMA Dermatol. 2017;153(8):802-809. doi:10.1001/jamadermatol.2017.2077

In this episode of Dermbusters, host Nicholas Brownstone, MD, sits down with Katherine Glaser, MD, a dermatologic surgeon specializing in Mohs surgery, about some common misperceptions heard from both colleagues and patients. Dr Glaser shares some insights on 2 frequently misunderstood topics: the use of lidocaine with epinephrine in the fingers and toes and the role of sunscreen in vitamin D absorption. Myth 1: Dermatologists should not use lidocaine with epinephrine in the fingers and toes. Contrary to a commonly held belief among dermatologists, Dr. Glaser emphasizes that there is robust data supporting the safe use of lidocaine with epinephrine in the fingers and toes. Despite concerns about vascular ischemia and resulting necrosis, studies from both dermatology and plastic surgery literature demonstrate the safety of lidocaine with epinephrine. Tips for advising colleagues: Share the existing data and research findings that support the safe use of lidocaine with epinephrine in the fingers and toes Highlight the lack of reported cases of ischemia with traditional lidocaine with epinephrine and contrast it with cases involving other substances, high concentrations of epinephrine, and improper tourniquet use Emphasize the importance of adhering to safe injection practices, proper dosage, and avoiding direct arterial injection to mitigate any potential risks Myth 2: Sunscreen should not be used because it prevents absorption of vitamin D. Next, Dr Glaser addresses a common myth that dermatologists often hear from their patients: that they shouldn’t use sunscreen because it prevents them from absorbing an adequate amount of vitamin D. While sunscreen does block the UVB rays that aid in vitamin D synthesis, the AAD advises against UV exposure solely for the purpose of absorbing vitamin D. Tips for counseling your patients: Explain that while sunscreen may affect vitamin D absorption, it's not a reason to skip it Highlight alternative sources of vitamin D, such as diet and supplements Encourage wearing sunscreen consistently and correctly Stress the importance of protecting the skin from harmful UV rays to prevent skin damage and reduce the risk of skin cancer

In this episode of Dermbusters, host Nicholas Brownstone, MD, chats with Anthony Rossi, MD, about some common misperceptions they often hear from their patients. Dr Rossi shares some suggestions on how to counsel patients on 3 significant topics: a misconception surrounding higher-percentage medications, the proper use of facial cleansers, and the necessity of wearing sunscreen during the winter months. Myth 1: Higher-percentage ingredients mean a medication is more efficacious. Dr Rossi begins by addressing the prevalent belief that higher percentages of ingredients in medications indicate greater efficacy. Contrary to this notion, he emphasizes that the right amount, rather than the highest percentage, is the key to achieving optimal results. Patients are advised to focus on key or active ingredients, striking a balance between not being the first or last listed in a formulation. Striving for a middle ground ensures effectiveness without causing unnecessary irritation. Tips for counseling your patients: Advise them to look at their product’s ingredient list. The active ingredient should neither be the first nor the last listed. Being the first suggests it's the highest percentage, while being the last indicates it's the lowest. Suggest they aim to find a product with the active ingredient listed somewhere in the middle. Caution them that certain ingredients, such as vitamin C, can actually be irritating in higher concentrations. Myth 2: You must wash your face for 60 seconds for maximum effectiveness. Dr Rossi supports this popular notion that washing the face for at least 60 seconds maximizes impact, with one important caveat: water alone is not an effective cleanser. He emphasizes the importance of a good cleanser and advises patients to focus on contact time; he recommends keeping cleanser on the face for at least 60 seconds to allow the active ingredient to work. Tips for counseling your patients: Advise patients not to wash with water alone, especially if they wear makeup or live in an urban environment and are exposed to daily pollution. Suggest they apply their cleanser, let it become sudsy, then brush their teeth before washing it off. This ensures the cleanser is making contact with their skin for at least one minute. Myth 3: Sunscreen isn’t necessary in the winter. Next, Dr Rossi addresses a myth that dermatologists hear often: sunscreen isn’t necessary in the winter or on cloudy days. Dr Rossi underscores that significant amounts of both UVA and UVB rays can still reach the skin even in the winter months and that sun protection is still important. Tips for counseling your patients: Show them images from the New England Journal of Medicine article “Unilateral Dermatoheliosis” by Gordon et al, which showcases photoaging on one side of a truck driver’s face and serves as an impactful visual aid that UVA can be transmitted through window glass.Explain that the light reflection from snow can amplify sun exposure when engaging in outdoor winter activities. Advise them to look for a sunscreen that offers both an SPF of 30 or higher and UVA protection.