Integrative Medicine is now taking hold in the specialty of Dermatology. If you haven’t heard of it, Integrative Medicine makes use of a wider variety of therapies, some ancient, some alternative, along with conventional medicine, to help patients heal. The lifestyle and diet of patients are more closely examined and recommendations for changes are made to treat or prevent disease or symptoms.
For my field there are many interconnections between the gut and the skin. For example, we know that weight lifters who use whey protein supplements can worsen their acne. Dairy, or a high glycemic diet can also cause acne.
Recent studies have shown that the gut bacteria of patients with inflammatory skin diseases like acne or psoriasis is different—with less of the microbiota needed to control inflammation. Introducing probiotics to the gut may have some effect on improving acne. Probiotics may be considered a therapeutic option for acne, to provide a synergistic, anti-inflammatory effect when used in combination with oral antibiotics.
So what else can you do to improve your gut health? Reduce stress! Your whole body makes changes when it gets ready for “fight or flight.” If you are under stress for a prolonged period, that’s when the unhealthy bacteria take over in the gut and cause inflammation, which in turn can be exhibited in your skin as acne, eczema or rosacea.
Many viruses like herpes simplex, chicken pox, measles, and now COVID-19, have prominent cutaneous physical findings.
Measles is a virus that is on the rise again in the United States because of decreased adherence to vaccination programs. Measles is spread by respiratory droplets and has a long incubation period of 10-12 days. Fever, conjunctivitis and malaise begin before the rash. The skin manifestations are red blotchy patches that typically start on the face around the ears, cheeks and neck then spread to involve the body. One key feature is called Koplik’s spots — tiny blue white dots inside the mouth.
Erythema infectiosum (Fifth disease)
One of the easiest viral rashes to identify is Erythema Infectiosum (Fifth Disease). It is caused by human parvovirus B19. After about the 10th day of asymptomatic infection, there is a mild fever, malaise and headache. The rash begins a few days later with a strikingly red raised patches over the cheeks (likened to slapped cheeks). It is followed by red patches over the buttocks, arms and legs. Adults have more symptoms like fever and not feeling well. When in doubt, antibody testing is very reliable. IgM, the initial antibodies, help me to confirm the case and last only a few months. Long term antibodies are the IgG and can last a lifetime.
Chicken Pox (Varicella) is caused by the same virus as Shingles (Herpes Zoster), a herpes virus (DNA virus) also spread by respiratory droplets. Interestingly the incubation period can be as long as 23 days for chicken pox. Again fever and malaise for a few days followed by crops of blisters predominately on the face and scalp. The rash is very itchy. Chicken pox can cause lots of complications like encephalitis and varicella pneumonia.
The second stage of chicken pox typically presents in adulthood, although children can get it also. There is no convincing evidence that shingles can be contracted from another individual. The virus is an opportunist and reactivates when an individual is immunosuppressed, or when a purely personal event allows the virus to resurrect. Most of you are aware that shingles follows one side of the body and corresponds to a dermatome (skin surface along a nerve branch). Shingles can be mild or extremely painful with complications like facial palsy, involvement of the eye and postherpetic long-lasting pain.
Herpes simplex, warts and molluscum contagiosum are other viral diseases of the skin. There are numerous others.
The most recent health care crisis with COVID-19 has brought us a variety of skin presentations. Reports are now storming the medical journals with skin rashes from COVID-19. Early reports suggest about 20% of patients have skin findings including generalized hives, small bruise-like rashes, frostbite-like changes in the fingers and toes and a red lacelike rash known by dermatologists as “livedo reticularis.”
Rashes start at the onset of COVID-19 symptoms or shortly thereafter. The rashes most commonly affect the trunk with itch that was mild or absent and resolved after a few days. The earliest reports of frostbite or purple fingers and toes were most commonly seen in those who were critically ill. Now, the dermatologic registry is expanding and most COVID toes are reported in younger patients, 20-30, who are recovering.
I have not encountered skin findings of COVID-19 as of yet with any of my patients.
I hope and pray that one of the good things that comes out of this crisis is that more and more people will realize the necessity of vaccination to prevent the spread of disease in the community. More than ever, I have encountered parents who refuse to vaccinate their children because they believed propaganda that vaccines are pushed on us for big pharma to make profits. Now there are concerns that vaccination rates are dropping further as more kids are missing vaccines due to the pandemic.
One of my earliest childhood memories is receiving the polio vaccine as a child with all of my family. A heartfelt thanks to Jonas Salk, the physician that ended the terror of polio by developing the polio vaccine released on April 12, 1955. He was a viral expert recruited by my undergraduate alma mater, the University of Pittsburgh. I attended pharmacy school classes in Salk Hall.
I have a very strong feeling about the importance of vaccination and I hope that this latest pandemic will help more people realize we need to vaccinate to prevent disease.
I’m excited to
let you know that we’ve moved into our new location right next door to our
former office. Our new address is:
100 N Federal Hwy, Suite 202 Hallandale Beach, FL 33009
The new building is on the corner of US1 and NE 1st St (in between Flanigan’s and our old building). It is a white 5-story with an “Accesso Partners” sign at the top of the south side. Directions via Google Maps.
Enter from the parking lot door and you’ll find a directory. We are on the second floor in Suite 202. There is an elevator.
numbers and email addresses remain the same.
Our office hours are:
1 pm – 5 pm
am – 5 pm
am – 3 pm
Not only have
we upgraded our facility, but we have also
added new technology and skincare to address your skin challenges.
upgraded our radio frequency microneedling
treatment to the Genius (it is more comfortable with quicker and better results
than Infini. And, less downtime!)
I’m now performing Mohs skin cancer surgery in the office several times a month. Mohs is often done on the face to retain as much non-cancerous skin tissue as possible to reduce scarring.
Thank you for being
a patient. I appreciate your support of
my practice. It means so much to
me. I’m thrilled to continue to provide
you with the best dermatologic services, now in a brand new venue. I look forward to seeing you soon!
·In the News·Comments Off on Paparazzi in Hollywood Florida
Recently I attended the Florida Society of Dermatology and Dermatologic Surgery conference in Hollywood Florida.
I was nominated for best cosmetic dermatologist and you can see how we had to run from the paparazzi on the red carpet at the award ceremony event.
Seriously, Terri Cronin, FSDDS president, did an outstanding job of putting together great speakers this year. I am pictured (second from right) with (from l to r) Jacqueline Dosal MD, of Skin Associates, Keyvan Nouri MD, Mohs surgeon at the University of Miami and Terri Cronin MD. Paparazzi at either end of our line up — unknown!
I stay up-to-date by attending medical conferences with world class faculty. I love learning new techniques that will help my patients.