Topical Conversations

In this episode of Topical Conversations, Charlie Dunn, MD, shares timely and practical tips for dermatologists to counsel their patients through the winter season. With stress, cold weather, indoor heating, and disrupted routines taking a toll on skin health, Dr Dunn outlines his top 3 counseling pearls dermatologists can share with patients to help them proactively manage common seasonal challenges. Proactive treatment for winter flare-ups: Dr Dunn highlights the importance of proactive care for conditions that frequently flare during the winter, such as rosacea, atopic dermatitis (AD), psoriasis, and Raynaud's phenomenon: Rosacea: Since triggers like cold weather, stress, alcohol, and hot drinks may be difficult to avoid for some patients, Dr Dunn recommends augmenting treatment plans with systemic therapies, such as oral doxycycline, to maintain control AD and psoriasis: Preventative topical anti-inflammatory therapies, such as steroids, applied to commonly flared areas—even if they appear clear or in the very early stages of a flare—can help prevent progression. He suggests a Monday-Wednesday-Friday application schedule for ease of adherence. Raynaud’s phenomenon: For patients who are hesitant about oral therapies, Dr Dunn discusses topical options, including 5% sildenafil cream, citing a 2018 JAAD study showing improved blood flow and vessel diameter,1 in addition to practical measures like hand warmers, gloves, and socks for warmth Passive and active skin hydration: To combat winter dryness, Dr Dunn advises dermatologists to provide actionable hydration strategies and provides an easy-to-remember system to share with patients: Passive hydration: Encourage patients to use cool-mist humidifiers, drink more water, reduce indoor thermostat temperatures, and minimize irritants like retinol. Active hydration: Dr Dunn introduces the 4 C’s of moisturization: Cream: Switch from lotions to thicker creams Cover: Use gloves or socks after moisturizing Clean skin: Moisturize after showers and handwashing Chapped lips: Be proactive with lip balm before lips become cracked Don’t neglect sun protection: Dr Dunn reminds dermatologists to emphasize to their patients that UV exposure remains significant in winter, particularly for patients with photosensitive conditions like melasma. Snow can reflect up to 80% of UV rays, far more than sand or sea foam.2 He emphasizes year-round sun protection to his patients, including broad-spectrum sunscreen, protective clothing, sunglasses, and shade-seeking behaviors. These 3 pearls offer dermatologists actionable tools and patient-centered strategies that are easy to implement to help guide patients through the challenges of the winter season. By taking a proactive approach to flare prevention, emphasizing both passive and active skin hydration, and reinforcing year-round sun protection, dermatologists can help patients maintain healthy skin and minimize seasonal exacerbations.

For National Healthy Skin Month, we’re spotlighting skin health practices across all stages of life. In this segment, Daniel Butler, MD, Associate Professor at the University of Arizona College of Medicine, offers his expert guidance on caring for the skin of older adults. Highlighting the unique needs of this patient population, he provides actionable pearls for both patients and dermatology providers to maximize care and prioritize quality of life (QoL).Addressing skin care for older adultsOlder adults represent a significant portion of dermatology patients, with nearly 50% of all visits involving individuals over the age of 65. Dr Butler emphasizes that their skin requires targeted attention as it undergoes significant changes with aging.For patients, his advice is straightforward but impactful: advise them to moisturize frequently. As skin ages, it loses moisture and its natural barrier weakens, leading to increased dryness and sensitivity. Considerations for providersFor providers, Dr Butler underscores the importance of prioritizing quality of life when treating older patients. Often, there is no one-size-fits-all solution for this population, and treatment decisions frequently exist in a gray area. He encourages dermatologists to have open discussions with their patients about their daily activities and sleep, 2 critical factors for maintaining overall well-being.Additionally, he highlights the importance of encouraging patients to stay active. Citing input from geriatricians, Dr Butler stresses that older adults should not stop exercising or walking, even after surgeries. Key takeaways for dermatologistsDr Butler’s guidance centers on 2 essential points for caring for older adult patients:Encourage patients to moisturize frequently to bolster the skin barrier and combat age-related drynessPrioritize quality of life in treatment decisions, focusing on maintaining sleep, activity levels, and overall well-beingThrough these approaches, dermatologists can provide meaningful care for this important and often underserved patient population. Watch Part 1 here for expert insights on caring for dermatology's youngest patients, Part 2 here for tips on managing adolescent and young adult patients, and Part 3 here for strategies to optimize skin health in adults and middle-aged patients—all for National Healthy Skin Month!

For National Healthy Skin Month, we’re spotlighting skin health practices across all stages of life. In this segment, board-certified dermatologist Dr Gabriela Maloney shares evidence-based strategies for managing skin health in adults and middle-aged patients. Highlighting preventative, therapeutic, and cosmetic interventions, Dr Maloney provides practical pearls for dermatologists to enhance outcomes and improve quality of life for their patients. Sun protection: the cornerstone of skin health Dr Maloney emphasizes that broad-spectrum sunscreen with an SPF of 30 or higher is essential for preventing photoaging and reducing the risk of nonmelanoma skin cancers. Evidence has demonstrated significant benefits, including a 40% reduction in the incidence of invasive squamous cell carcinoma and a 24% decrease in actinic keratoses over 4 years with daily SPF 30 use compared to SPFs of lower formulations. Educating patients on proper application techniques and the importance of reapplying every 2 hours, especially during outdoor activities, is critical. The "magic trifecta" for anti-aging Counseling this patient group on anti-aging, Dr Maloney recommends a simple yet effective regimen: sunscreen, vitamin C, and retinoids. She advises patients that vitamin C, known for its ability to neutralize free radicals, brighten skin, and boost collagen synthesis, is particularly effective when paired with sunscreen. Retinoids, including prescription tretinoin and over-the-counter retinols, promote epidermal turnover and dermal remodeling, reducing fine lines, hyperpigmentation, and acne. Counseling patients to start with low concentrations and gradually increase use minimizes irritation and ensures a positive experience. Expanding the toolbox with additional ingredients For patients seeking advanced options, Dr Maloney advises patients that they may benefit from ingredients like azelaic acid and glycolic acid. Azelaic acid offers anti-inflammatory, antimicrobial, and depigmenting properties, making it ideal for rosacea, melasma, and acne. Glycolic acid facilitates exfoliation, improves collagen production, and enhances skin tone and texture, providing versatile benefits. Chemoprevention and skin cancer surveillance In high-risk populations, Dr Maloney recommends proactive interventions such as nicotinamide supplementation, with evidence suggesting that 500 mg twice daily may help significantly reduce the incidence of new actinic keratoses and cutaneous squamous cell carcinoma. Regular full-body skin examinations and patient education on self-surveillance are essential for early detection of skin cancers, improving outcomes and survival rates. Integrating preventative, therapeutic, and aesthetic care Dr Maloney highlights the importance of combining evidence-based recommendations with personalized care to optimize patient outcomes. By integrating preventative measures, therapeutic treatments, and cosmetic enhancements, dermatologists can elevate patient satisfaction and quality of life. Key takeaways for dermatologists Prioritize sun protection: Educate patients on proper application and the importance of reapplication Simplify anti-aging regimens: Recommend the "magic trifecta" of sunscreen, vitamin C, and retinoids for effective and evidence-based anti-aging benefits Proactive interventions: Utilize nicotinamide supplementation for high-risk populations and ensure regular skin cancer screenings paired with patient education on self-surveillance Integrate care approaches: Combine preventative, therapeutic, and aesthetic strategies to provide personalized, evidence-based care that enhances patient outcomes and quality of life Check out Part 1 here for expert insights on caring for the skin of dermatology's youngest patients, Part 2  for tips on managing adolescent and young adult patients, and Part 4 for guidance on caring for the older adult patient population—all for National Healthy Skin Month!

For National Healthy Skin Month, we’re spotlighting skin health practices across all stages of life. In this segment, Dr Nicholas Brownstone shares his expertise on managing patients in the adolescent and young adult demographic—a pivotal stage where dermatologists must consider not only physical health but also mental well-being. Understanding the adolescent perspective Dr Brownstone highlights that skin changes throughout life, as do our psychology and worldview. These shifts are particularly pronounced during adolescence, a time when many patients first develop social anxieties tied to their appearance. At this stage, patients are still forming their sense of identity, and even minor skin issues can feel monumental. Dermatologists must recognize the unique emotional weight that acne carries for this group and avoid dismissing their concerns—a practice Dr Brownstone refers to as “empathetic failure.” The psychological impact of acne According to Dr Brownstone, adolescence is often the life stage where acne has the greatest psychological impact. He emphasizes that even a single pimple can feel like “the end of the world” for these patients. This perspective supports the importance of taking their concerns seriously and tailoring treatment approaches to meet their emotional as well as physical needs. Pearls for treating acne in adolescents Dr Brownstone advises dermatologists to approach acne treatment in adolescents differently than in pediatric or adult patients. Key considerations include: Empathy first: Understanding the adolescent perspective and avoiding dismissive responses that could alienate patients Individualized treatment: Acknowledging that not all acne cases are equal and adjusting treatment plans accordingly Aggressive treatment when needed: Dr Brownstone suggests that even one pimple may justify aggressive treatment options, including isotretinoin, if the acne is perceived as life-ruining by the patient. Key takeaways for dermatologists As dermatologists, it’s crucial to consider both the physical and emotional impacts of acne on adolescent patients. Dr Brownstone encourages his colleagues to view this demographic through a compassionate lens, understanding their unique challenges and tailoring care to meet their needs effectively. By fostering empathy and delivering personalized care, dermatologists can make a profound difference in the lives of their adolescent patients, helping them navigate this critical stage with confidence and better skin health.Watch Part 1 here for expert insights on caring for dermatology's youngest patients, Part 3 here for strategies to optimize skin health in adults and middle-aged patients, and Part 4 here for guidance on caring for the older adult patient population—all for National Healthy Skin Month!

In this episode of Topical Conversations, Dr Nick Brownstone highlights the critical role dermatologists play in addressing the mental health impact of skin conditions. For World Mental Health Day on October 10, Dr Brownstone emphasizes the importance of raising awareness about how dermatologic diseases affect patients' mental well-being. Mental health and skin disease: a quality-of-life issue Dr Brownstone opened by reminding dermatologists that while skin conditions like acne, psoriasis, atopic dermatitis, alopecia areata, and vitiligo may not be life-threatening, they can drastically reduce a patient's quality of life and urging his colleagues to consider the potential mental toll these conditions can take on patients. He stressed the importance of dermatologists taking a moment to ask their patients a simple but impactful question: Is this condition significantly affecting your quality of life? Many patients may be hesitant to proactively raise this issue, and such a question can open the door to discussions about their mental health and how their skin condition impacts their daily life. The connection between dermatology and mental health Dr Brownstone cited recent studies that have confirmed the negative mental health impacts associated with dermatologic conditions. One finding, published in JAMA Dermatology, demonstrated that patients with atopic dermatitis had a higher prevalence of suicidal ideation and attempts compared to the general population. He noted the seriousness of this finding, emphasizing that dermatologists must be mindful of these risks when treating patients with chronic skin diseases. Another study discussed by Dr Brownstone was the Global Valiant Study on vitiligo, also published in JAMA Dermatology. The study found that patients with vitiligo often find difficulty with everyday activities, such as choosing clothing or going to the beach, due to the psychological burden of their condition. These daily limitations, often overlooked, can severely impact their quality of life, highlighting the need for dermatologists to acknowledge the emotional and psychological effects of skin diseases. Addressing mental health in dermatology: simple and effective steps Dr Brownstone advised dermatologists to take 2 simple steps when a patient expresses that their skin condition is negatively impacting their mental health: Offer more aggressive therapy: For patients whose current treatments may not be addressing their symptoms sufficiently, considering more intensive options could help improve both their physical and mental well-being. Provide mental health support: If a patient's condition is having a severe psychological impact, dermatologists should not hesitate to recommend mental health resources. Dr Brownstone emphasized the value of referring patients to therapists or connecting them with patient support organizations. He mentioned several helpful resources, including the National Psoriasis Foundation, National Eczema Foundation, Vitiligo Research Foundation, and Global Vitiligo Foundation, all of which offer support and community for patients dealing with the emotional burden of their skin conditions. World Mental Health Day: a reminder for all healthcare providers Dr Brownstone concluded the discussion by urging his colleagues to always be mindful of the mental health aspects of skin conditions, reminding dermatologists to ask about mental health regularly and act when necessary. By addressing the often-overlooked psychological toll that skin diseases can take, dermatologists can help improve not only their patients' skin health but also their overall well-being, making a lasting difference in their quality of life.

In this episode of Topical Conversations, dermatologists Nicholas Brownstone, MD, and Alexandra K. Golant, MD, address the critical yet often overlooked issue of touch starvation, particularly affecting patients with inflammatory skin conditions. This discussion highlights how touch starvation impacts patients' overall quality of life and offers practical advice for clinicians on how to address this issue. Understanding touch starvation Touch starvation, in the context of dermatology, is a multifaceted issue with significant implications for patients with inflammatory skin diseases. From a clinical perspective, touch starvation can manifest as patients feeling isolated and less engaged with their health care providers. This reduced interaction may hinder providers from fully assessing the severity of the disease and its impact on the patient’s quality of life. Consequently, patients may suffer silently, experiencing challenges that health care providers may not fully appreciate. Another dimension of touch starvation involves the social and emotional isolation that often accompanies inflammatory skin conditions. This isolation can lead to various negative outcomes, such as mental health issues, social anxiety, and withdrawal from daily activities. Addressing these concerns is crucial for improving the overall well-being of patients and ensuring that clinicians are more attuned to the broader impacts of these conditions. Impact of touch starvation on quality of life Touch starvation significantly affects the quality of life for patients with conditions like psoriasis and atopic dermatitis. Patients may experience a substantial burden, which is often underreported. If clinicians do not actively inquire about quality of life, they may miss crucial insights into how the disease affects the patient's mental health, self-esteem, and interpersonal relationships. Many patients are not proactive in discussing their emotional distress or the extent to which their condition impacts their lives. Therefore, it is essential for health care providers to proactively assess quality of life to better understand the severity of the disease and adjust treatment plans accordingly. Inadequate recognition of touch starvation can lead to undertreatment, leaving patients with a diminished quality of life. Identifying touch starvation in patients To effectively identify touch starvation and its impact on patients, clinicians can adopt several strategies: Frequent follow-ups: It is important to schedule more frequent visits for patients who appear to be struggling or whose condition may be worsening. Shorter follow-ups can help ensure that providers stay updated on the patient’s condition and make timely adjustments to treatment. Intentional dialogue: During clinic visits, take the time to engage in meaningful conversations about the patient’s quality of life. Ask specific questions about how their disease affects their daily activities, sleep, and overall well-being. Open-ended questions, such as “What activities are you unable to do because of your condition?” can provide valuable insights. Holistic care: Regular follow-ups are crucial for identifying mental health strain or comorbidities that may not be immediately apparent. A comprehensive approach to patient care can reveal underlying issues that need to be addressed alongside the primary skin condition. Supporting patients with low self-esteem and poor body image For patients experiencing low self-esteem or poor body image due to their disease, several strategies can help: Access to advanced therapies: The advent of new treatments has provided hope for many patients. Informing patients about advanced therapeutics can offer them a sense of optimism and encourage them to engage more actively in their treatment plan. Support groups: Connecting patients with support groups, either through national organizations like the National Psoriasis Foundation or the National Eczema Association or through local and online communities, can provide valuable social support. These groups offer a space for patients to share experiences and find encouragement from others facing similar challenges. Interdisciplinary team: Leveraging an interdisciplinary approach, including mental health professionals and primary care providers, can address the holistic needs of patients. This team-based care model ensures that patients receive comprehensive support, addressing both their physical and emotional health. Touch starvation is a significant issue for patients with inflammatory skin diseases, impacting their quality of life and overall well-being. By understanding and addressing this issue, clinicians can improve patient care and outcomes. Regular follow-ups, intentional dialogue, and access to advanced treatments and support resources are essential for effectively managing touch starvation and enhancing the quality of life for these patients. For more resources, the National Psoriasis Foundation and the National Eczema Association offer valuable support and information for both patients and providers.

In this episode of Topical Conversations, Dr Ahuva Cices, assistant professor at Icahn School of Medicine at Mount Sinai, introduces why it is crucial for dermatologists and the public to understand the differences between physical and chemical sunscreens and their mechanisms of action (MOA). Common misconceptionsDr Cices addresses a common misconception: that physical sunscreens primarily work by reflecting and scattering UV light. While this was historically true, she clarifies that this is now only a small part of how modern physical sunscreens function.1 Instead, physical sunscreens predominantly absorb UV light, similar to chemical sunscreens. This challenges the outdated understanding that reflection and scatter are the main protective mechanisms of physical sunscreens. Modern mechanism of action With the advent of micronization and nanoparticle technologies, modern physical sunscreens containing zinc oxide and titanium dioxide have shifted their primary mechanism to UV light absorption.2 One study demonstrated that these modern formulations reflect less than 5% of incoming UV light,3 with the majority of protection coming from absorption and subsequent energy dissipation as heat.2,4 Implications for dermatologists and patients Understanding the MOA of modern physical sunscreens is essential for dermatologists when advising patients. While some dermatologists may prefer physical sunscreens due to their perceived safety and simplicity,1 it is important to recognize that both physical and chemical sunscreens now work via similar mechanisms. Therefore, factors like cosmetic elegance and ease of use become more significant when recommending sunscreens to patients. Dr Cices advocates for dermatologists to stay informed about the current MOA of sunscreens. Dispelling myths and prioritizing user-friendly, cosmetically elegant products can help dermatologists guide their patients in choosing effective sun protection, ultimately enhancing compliance and reducing the risk of sun damage. References Zundell M, Wong M, Rubin C, Cices A, Bitterman A. Improving patient communication on sunscreen choice: Updating mechanistic misconceptions. JEADV Clin Pract. 2023;2:963-964. doi:10.1002/jvc2.251 Smijs T, Pavel S. Titanium dioxide and zinc oxide nanoparticles in sunscreens: focus on their safety and effectiveness. Nanotechnol Sci Appl. 2011; 4: 95–112. doi:10.2147/NSA.S19419 Cole C, Shyr T, Ou-Yang H. Metal oxide sunscreens protect skin by absorption, not by reflection or scattering. Photodermatol Photoimmunol Photomed. 2016; 32(1): 5–10. doi:10.1111/phpp.12214

In this quick-hitting installment of Topical Conversations, Aaron Farberg, MD, gives a concise and effective tip for preventing sharps injuries among Mohs surgeons and staff.Prevalence and underreporting A recent survey of Mohs surgeons with membership in the American College of Mohs Surgery found that 56.7% have reported at least one sharps injury in the past year, mostly self-inflicted, of which 14.7% resulted in bloodborne pathogen exposure. Compounding this issue is the tendency to underreport, with 44.1% of the injured surgeons stating that they did not report their injuries.1 Another study that surveyed Micrographic Surgery and Dermatologic Oncology fellows about sharps injuries concluded that the most common reason for not reporting was a perceived low risk of infection.2 However, the risk of viral transmission following a sharps injury, while generally low, varies based on factors such as transmission mode and patient source risk factors.3 A succinct strategy for reducing injuries As a practicing Mohs surgeon, Dr Farberg recognizes the critical role of practice in preventing such incidents, advocating for a culture of perfect practice within his clinic. He emphasizes the importance of ensuring that every member of the surgical team is well-versed in their respective roles and responsibilities to minimize the likelihood of errors. Developing and disseminating a standardized sharps handling protocol can also help mitigate the risk of injury among dermatologic surgeons and their staff.1 The prevalence of sharps injuries among Mohs surgeons, coupled with the tendency to underreport these injuries, underscores the need for proactive measures to enhance workplace safety. By implementing proper training and standardized protocols, clinics can mitigate the risk of sharps injuries and safeguard the well-being of both surgeons and their staff. References Talebi-Liasi F, Lewin JM. A cross-sectional analysis of sharps injuries among dermatologic surgeons: a survey of American College of Mohs Surgery members. Dermatol Surg. 2023;49(11):985-988. doi:10.1097/DSS.0000000000003907 Santillan MR, Salian P, Weiss J. Sharps injuries during micrographic surgery and dermatologic oncology fellowship training. Dermatol Online J. 2022;28(6):17. Brewer JD, Elston DM, Vidimos AT, Rizza SA, Miller SJ. Managing sharps injuries and other occupational exposures to HIV, HBV, and HCV in the dermatology office. J Am Acad Dermatol. 2017;77(5):946-951.e6. doi:10.1016/j.jaad.2017.06.040

In this special edition of Topical Conversations, Charlie Dunn, MD, provides an overview of the American Academy of Dermatology’s (AAD) Camp Discovery and how you can get involved with this uniquely valuable experience for pediatric patients. Applications are open until April 2, 2024, representing a chance to make a lasting impact on the lives of children with chronic skin conditions. What is Camp Discovery? Established in 1993 by the AAD, this multisite, weeklong program offers children living with chronic skin conditions a unique summer camp experience. Provided at no cost to families, Camp Discovery welcomes pediatric patients with conditions including eczema, psoriasis, vitiligo, alopecia, epidermolysis bullosa, ichthyosis, and more. An invaluable experience for children with chronic skin conditions Studies have demonstrated that after participating in Camp Discovery, children with chronic skin conditions have a better understanding of their condition, improved symptom control, better social functioning, and higher overall quality of life. Benefits for the clinician The benefits of Camp Discovery extend beyond the campers; medical volunteers also experience a substantial positive impact by participating. One study demonstrated that 97% of medical volunteers encountered skin conditions at Camp Discovery they had not previously seen, and 93% report it as one of the best rotations they’ve undertaken. Engaging in this program opens doors to networking opportunities, establishes lifelong mentor-mentee relationships, enhances knowledge of complex diseases, and fosters multidisciplinary communication. Importantly, this opportunity is not exclusively for pediatric specialists; volunteers include both adult and pediatric dermatologists who span medical, cosmetic, and surgical dermatology. How to get involved Be a volunteer: Sign up to be a medical volunteer and contribute your expertise to this life-changing experience. Refer your patients: Encourage your patients to apply and witness the transformative impact of Camp Discovery on their lives. Change a life: By participating, you have the power to make a positive difference in the lives of children.