Dermbusters

Do patients with skin of color need sunscreen?First, Dr. Brownstone asks Dr. Elston how to advise patients with skin of color who believe they don’t need sunscreen. Dr. Elston references studies that show not only do patients with skin of color get skin cancer, they also tend to get diagnosed later and have higher mortality.She details a study that examined melanoma survival among White, Hispanic, Asian, and Black women, which demonstrated that those with skin of color had lower survival rates, with Black women having the lowest.To encourage sunscreen use among her patients with skin of color, Dr. Elston recommends products that will be more cosmetically favorable on pigmented skin; some of the physical blockers can be challenging, so she often recommends sunscreens that are in a clear- or a gel-base that will rub in.If a topical medication isn’t burning, does that mean it’s not working?Next, Dr. Brownstone chats with Dr. Elston on a common misperception heard from patients—if a topical medication isn’t burning, it isn’t working.Dr. Elston explains that many medications burn or sting because of what’s in the vehicle, like lactic acid affecting patients who are sensitive to cosmetic products or propylene glycol causing an irritant effect. She explains to patients that the resulting stinging is not a result of the products’ efficacy. She also explains that other drugs cause burning because of the drug effect, for example, topical calcineurin inhibitors causing a capsaicin-like burning reaction that often gets better the longer patients use them. She helps dispel this common misconception by advising patients that these medications work just as well when the burning stops.

In this episode of Dermbusters, Dr. Nick Brownstone chats with Dr. Aaron Farberg how he busts myths often heard from patients surrounding sunscreen use and scarring.Is a higher SPF sunscreen always better?First, Dr. Brownstone asks Dr. Farberg how he counsels patients who believe a higher SPF sunscreen is always better. Dr. Farberg explains that when he chats with patients about sunscreen use, he emphasizes that the best sunscreen is whichever one they will use consistently.He tells his patients that an SPF of 30 is sufficient if they are using it correctly; however, he notes that most people do not, either by not applying enough or not reapplying their sunscreen. Considering that, he advises his patients to select the highest SPF sunscreen they can find to give themselves a margin of safety.Is a barely noticeable scar the mark of a good surgeon?Next, Dr. Brownstone inquires about a misconception regarding scarring that he often hears from patients: that a barely noticeable scar is the mark of a good surgeon. Dr. Farberg emphasizes that for patients who hold this belief, managing expectations is key and advises them that they should expect a scar.He describes his system of measuring scars by distance—whether the scar is visible from 3 feet, 30 feet, or 300 feet—and that he explains to his patients that he aims for scars that can only be visible from 3 feet away.

In this episode of Dermbusters, Dr. Nick Brownstone asks Dr. Dawn Sammons how she dispels myths often heard from patients about tanning and tretinoin use.Does a base tan prevent sunburn?First, Dr. Brownstone asks Dr. Sammons what she says to patients who believe getting a base tan prevents sunburn and the need for sunscreen. She explains to her patients that while a base tan may provide a very slight level of SPF, it does not prevent the need for sunscreen, and pretanning ultimately increases the amount of sun damage patients get. For patients still desiring the look of a base tan, she advises a spray tan. She notes that with social media often promoting misconceptions about base tans, dermatologists must work to help dispel these notions among their patients.Does tretinoin make you more sun-sensitive?Next, Dr. Brownstone chats with Dr. Sammons on the belief that tretinoin makes the skin more sun-sensitive. She states that while true, the slight decrease in minimum effective dose associated with topical retinoid use is not time-sensitive, and that skin won’t be any more sensitive in the daylight hours than in the evening. Considering this, she questions the reasoning dermatologists have for instructing patients to apply retinoid at night. Dr. Sammons explains that she encourages patients to apply their retinoid at whatever time they are most likely to adhere to. In her experience, her younger patients tend to have more consistent routines in the morning as opposed to at bedtime.She concludes by explaining that historically, retinoids were photolabile and thus deactivated by sunlight. As a result, dermatologists instructed patients to apply retinoids at night. Currently, however, all preparations are micronized and photostable for up to 8 hours, which is sufficient time for retinoid to be absorbed.