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Cynthia Golomb, MD | Dermatology Boutique

Dr. Cynthia Ann Golomb

Integrative Dermatology

· In the News · Comments Off on Integrative Dermatology

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.

 

A Melanoma Grew Large During Quarantine

· Skin Cancer · Comments Off on A Melanoma Grew Large During Quarantine

Back in January, I posted to social media this photo of my patient who developed a big melanoma during quarantine.  After hunkering down for months, she finally went to get her hair done and her hairdresser alerted her to the growth.  She came to see me immediately in December and the biopsy I did showed melanoma. She is now being treated by an oncology surgeon.

The melanoma was removed, but since her surgery, additional cancerous sites on her scalp have been found and removed.  She has also started immunotherapy to treat the cancer.  Patients with advanced melanoma have a better prognosis today because of immunotherapy.

Melanoma is a very serious cancer.  Don’t delay your annual or bi-annual skin check! It’s better if we catch skin cancer before it grows this big. I take precautions in the office for COVID-19 to keep you safe during your exam.

When you’re checking yourself for new moles or growths, the one place on your body that is difficult to check is your scalp. Unfortunately, melanomas on the scalp are more deadly than on other locations of the body. This could be due to a number of factors including the anatomy or biology of the scalp and the fact that the melanoma can go undiscovered by the patient because it is hidden by hair.

A thorough skin exam by a board certified dermatologist is so important to locate hard-to-find skin cancers. In addition, on an ongoing basis, you can ask your hair care professional to let you know if he or she sees anything unusual on your scalp during your haircuts.

Melanoma is the most deadly skin cancer because of how quickly it spreads in your body.

Symptoms and the appearance of a cancerous lesion can vary widely and sometimes they are not obvious. It could be painful or sensitive to the touch, but not necessarily. It might bleed. And it could be just about any color or a combination of colors: brown, black, white, red and even blue. It could be raised or flat. Look carefully because these spots can be very small.

A recurring theme I’ve seen in my career is even when a primary care physician refers a patient to a dermatologist due to a scalp lesion or any other suspicious spot, the patient delays a few months in making the appointment, and by that time the skin cancer has spread to the lymph nodes or other parts of the body.

My patient granted Dermatology Boutique permission to post her photo on my social media and patient communications. I am grateful that she allowed me to share her photo to help educate my other patients and social media followers.

 

View Recording of RHA Collection Virtual Event

· Fillers · Comments Off on View Recording of RHA Collection Virtual Event

Did you miss my Virtual Event?
No worries. A recording is on my YouTube channel.

When you watch, you’ll learn more about the RHA Collection of fillers. I tell you about this Swiss-made filler and I also treat patients, like Victoria in this photo, with RHA in the video.
Do you love fillers, but want a filler that looks even more natural and lasts longer?
Or, have you always wanted to try fillers but didn’t want to look “done?”
The RHA Filler Collection lasts longer than other fillers, up to 15 months. It was created to be more like the natural hyaluronic acid in your skin.
RHA is also designed to perform in the most dynamic areas of the face without looking stiff or unnatural.

The tragedy of misinformation

· COVID-19 · Comments Off on The tragedy of misinformation

Allure magazine wrote a good article about all the misinformation out there about dermal fillers and the COVID-19 vaccine.

I think it is a tragedy that many filler patients refused to get vaccinated because of the misleading reports in the news media.  Some reporting caused panic, confusion and concerns that were out of proportion to the actual, rare events that resolved quickly.

Yes, there have been a few, rare reactions to the COVID vaccine in filler patients, but these types of reactions are not new, nor are they unique to the COVID vaccine.

Click to read the Jan. 20, 2021 article:  “Why You Should Still Get the COVID-19 Vaccine Even If You Have (or Plan to Get) Dermal Fillers.”

 

Festoon Update

· Lasers · Comments Off on Festoon Update

Earlier I posted a video of the CO2 CoolPeel laser treatment to reduce the festoons under my eyes.  Now with these photos, you see what I looked like pre and post-procedure.

Festoons appear below the “eye bags” as a mound or bump around the cheekbones.  Or, a festoon could be sagging skin or folds of skin above the cheek.

I was red immediately after the laser treatment, but the CoolPeel has less downtime and less redness than older technology CO2 lasers.  The CoolPeel’s new technology delivers energy more precisely, without a lot of thermal damage to the skin, so recovery is faster.

The laser can be set to mild, moderate or aggressive and the downtime increases with the intensity of the treatment.

The treatment I had was moderate and addresses fine lines, superficial wrinkles, dark circles and festoons.  The cost for this treatment under the eyes is $850.  The downtime is 3 to 5 days.  You can begin wearing makeup in 2 to 3 days.

Laser resurfacing with a CO2 laser encourages the skin’s natural healing process and revitalizes the area by creating better support in the skin.  It also tightens the skin by “shrinking” tissue.

My CoolPeel CO2 laser can be customized to your unique needs — it is powerful, fast and gives fabulous results.  After your treatment, your skin will look smoother, tighter, fresher and more youthful.

CoolPeel CO2 Laser Reduces Festoons

· Lasers · Comments Off on CoolPeel CO2 Laser Reduces Festoons

Do you have festoons?  I do.  They are below the “eye bags,” a swollen area appearing as a mound or bump around the cheekbones.  Or, a festoon could be sagging skin or folds of skin above the cheek.  Festoons can be genetic and often get worse with aging, sun exposure, or smoking.

The puffiness under the eyes gets worse with age because the structural support of the skin is deteriorating and the muscles under the eyes weaken.  Lower eyelid surgery can sometimes improve the appearance, but it also can make the festoon look more prominent.

Laser resurfacing with a CO2 laser can encourage the skin’s natural healing process and revitalize the area by creating better support in the skin.

Click photo to view CoolPeel video

The laser you see in the video is the next generation of CO2 that has less downtime and less redness.  It has power and delivery that is unmatched in any other fractional carbon dioxide laser.  The CoolPeel CO2 uses carbon dioxide technology to deliver energy precisely, without a lot of thermal damage to the skin, thus a faster recovery.  It can be used for fine lines and to improve skin texture and pigment.  It also tightens the skin by “shrinking” tissue.

The laser can be set to mild, moderate or aggressive and the downtime increases with the intensity of the treatment.  The treatment in the video was moderate and will address fine lines, superficial wrinkles, dark circles and festoons.  The cost for this treatment under the eyes is $850 and full face is $1000.  The downtime is 3 to 5 days.

A mild treatment of the full face and neck to improve pigment, sun damage and texture is $850.  The downtime for a mild treatment is about 2 days.

An aggressive CoolPeel carbon dioxide laser ablation to treat skin laxity, acne scars, deep lines and wrinkles is $2000.  The downtime is 5 days.

My CoolPeel CO2 laser can be customized to your unique needs — it is powerful fast and gives fabulous results.  After your treatment, your skin will look smoother, tighter, fresher and more youthful.

Dermal Fillers and the COVID-19 Vaccine

· COVID-19 · Comments Off on Dermal Fillers and the COVID-19 Vaccine

In case you have not heard, during the Moderna vaccine trial, three participants who had facial filler injections experienced facial swelling after receiving the COVID-19 vaccine.

One of the three previously had a similar reaction to an influenza vaccine.  In all three cases, the swelling decreased with antihistamines or steroids.

As a result, the FDA has said “it is possible the localized swelling in these cases is due to an inflammatory reaction from interaction between the immune response after vaccination and the dermal filler.”

One of my professional organizations, the American Academy of Dermatology, has a registry of cases of dermatologic side effects of COVID-19 and the vaccines and is closely monitoring reports.

At this point this reaction appears to be rare, but I will keep you up-to-date if we learn more.

I will be vaccinated for COVID this week and I am not concerned, even though I have recently had filler.  I strongly believe the vaccine is very important.

If you have any concerns about being vaccinated because you have had filler, take an antihistamine the day before and the day of your COVID vaccine.  I recommend Zyrtec.

 

The face mask you wear matters

· COVID-19 · Comments Off on The face mask you wear matters

 

  • Scientific simulations have demonstrated that if 80% of the population wore face masks, the pandemic spread would slow to a point even better than a lockdown.
  • Masks with one-way exhalation valves can expel droplets of the coronavirus. They’ve been banned by hospitals, airlines and major U.S. cities.  If you wear a mask with a valve to my office, we’ll ask you to change into a mask that we provide.
  • While a one-layer cloth face mask reduces droplets, two layers are better.
  • The more form fitting your face mask, the better. Your face mask should cover your mouth and nose with no gaps at the sides.
  • The jury is out on neck gaiters. One reason is that they are one layer, another is the polyester fabric most are made of.  One study found they reduced large droplets into smaller ones and expelled those droplets.
  • Bandanas have also been found to be not particularly effective as a face mask.
  • A recent study in Japan found that a plastic face shield without a mask does not stop the spread of the coronavirus. A face shield or goggles will protect the mucous membranes of your eyes.  A face shield should always be used in conjunction with a mask.
  • Masks are not recommended for children under 2 years of age due to the risk of suffocation.

Mohs Provides Higher Cure Rate for Skin Cancer

· Skin Cancer · Comments Off on Mohs Provides Higher Cure Rate for Skin Cancer

Immediately after Mohs surgery.

I performed Mohs surgery and then did a skin graft on this patient.  She had basal cell cancer on her ear.

Mohs surgery is a precise technique to remove skin cancers layer by layer resulting in a higher cure rate than standard excision or radiation therapy.

For example, basal cell carcinomas have a 97 to 99% cure rate.

Mohs also allows me to limit the size of removal and conserve normal skin to minimize scarring.  After removal, I treat the wound in a manner to promote good healing and preserve cosmetic results.

The Mohs procedure can be as short as one hour as in the case of this patient, or it can take several hours depending on the number of layers and type of repair, like a skin graft.  This patient’s skin graft took an additional hour.

This photo was taken 11 days after her Mohs surgery and skin graft.

I became very interested in Mohs during my residency and training at the University of Miami, and then later during my dermatopathology fellowship at Roger Williams Hospital at Boston University.  A dermatopathologist diagnoses skin disorders under a microscope.

Removing a tumor and examining the tissue immediately after removal was a natural for me because of my sub-specialty as a dermatopathologist.

Designed by Frederic E. Mohs, M.D., the surgery excises not only the visible tumor but also any “roots” that may have extended beneath the surface of the skin.

This procedure is most commonly used for the treatment of basal and squamous cell carcinomas, the two most common types of skin cancer, although it can also be used to treat melanoma and other types of cancer.

Mohs surgery is often recommended for recurring cancer because its results are so thorough.

My patient 3 1/2 months after Mohs and her skin graft. Her face mask is pulling the top of her ear forward in this photo.

It is ideal for treating cancer in cosmetically and functionally prominent areas such as the nose, eyelids, lips, hairline, ears, hands and feet.

Compared to other skin cancer treatments, Mohs surgery has a very high success rate. As I mentioned, basal cell carcinomas have a 97 to 99% cure rate, while squamous cell carcinomas are cured 94% of the time.

Natural Does Not Necessarily Mean Safe

· In the News · Comments Off on Natural Does Not Necessarily Mean Safe

I’m a believer in science and clinical trials when deciding on what to recommend to patients for skincare and of course, pharmaceutical treatments.

But right now there’s a lot of money and social media influence spent on convincing you that some ingredients in skincare products are harmful.

What’s interesting is that the alternatives pushed by the clean beauty movement often result in skin irritation, infections or allergic reactions.

As you’ll see from this editorial in JAMA Dermatology, many useful and safe ingredients have been “demonized” without any scientific evidence.

Beware of marketing terms like “natural” and “clean” and look for clinical trials that demonstrate the results of the product and show the vast majority of testers did not have adverse reactions.

You can read the editorial from JAMA Dermatology here.

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