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Cynthia Golomb, MD | Dermatology Boutique

Dr Cynthia Golomb

The face mask you wear matters

· In the News · 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.

Kysse is new for lips

· Fillers · Comments Off on Kysse is new for lips

I injected my patient with the new Restylane Kysse and she looks amazing!  I only used ½ of a syringe, because she did not want “big lips.”

That’s the beauty of this new product.  I can use less product and still achieve a nice improvement in volume and texture.

Because it is soft and flexible I can shape the lip to the patient’s desire:  a French lip, heart shape or geisha lip, or other options for any age group.

The best news is that this filler lasts longer!  From nine months to possibly up to a year.

Using less filler that lasts longer translates to a value for my patients.

 

#Restylane
#RestylaneKysse
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#ExpertInjector
#DermatologyBoutique
#MiamiDermatologist
#BoardCertifiedDermatologist
#SkinDoctor
#Skincare
#HealthySkin
#HealthyBeautifulSkin

 

Returning to Full-Service Appointments

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I am happy to let you know that I have returned to full-service appointments.  That includes cosmetic procedures and full-body skin checks.  But things will be a bit different.  See below.  I look forward to seeing you soon!

Brilliant Distinctions® $100 gift card for just $50

· Neurotoxin (Botox, Dysport, Jeuveau and Xeomin) · Comments Off on Brilliant Distinctions® $100 gift card for just $50

We miss you!
Stay healthy, and take care of each other.

In the meantime, here’s some fabulous news!

You can get a Brilliant Distinctions® $100 gift card for just $50.
The limit is 4 per person. Visit Brilliant Distinctions to get yours.

The gift cards do not expire, can be combined with Brilliant Distinctions points and are redeemable on Botox, Juvederm and Kybella.

COVID-19 tips: wearing masks, gloves and a trick to keep your phone clean

· In the News · Comments Off on COVID-19 tips: wearing masks, gloves and a trick to keep your phone clean

On Earth Day I recorded this video to provide tips on safety for using masks and gloves, as well as a trick to protect your cell phone.

For example, use a paper towel, tissue or coffee filter to make your mask last longer. After your mask becomes damp from respiration, it is less effective.

While you are wearing your mask, or when taking it off, don’t touch the outside of your mask – that’s the contaminated side.


Stay safe!

Viruses, Your Skin and Vaccines

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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.

Hives

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.”

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.

Get dermatological care without leaving home

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I can now continue your care during these uncertain times with Telehealth appointments.  You can use your iPhone, iPad or Android device.

You could use your computer if you have a webcam and microphone (with Google Chrome or Mozilla Firefox as the browser), however if you want to show me a rash or lesion that is somewhere other than your face, a phone or tablet would be better.

This is what the Pocket Patient app looks like in the Apple App store.

If you’re going to use your mobile phone or tablet, you’ll need to download an app from my electronic health records system called “Pocket Patient.”  It is in the App store you use on your device.

The app is free.

When using a computer, you will sign into the patient portal.

Below are links to some videos to help you get the app and prepare for your Telehealth visit:

PocketPatient™ for iPhone

 PocketPatient™ for Android

 Telehealth using the Patient Portal on a computer

Make your appointment for a Telehealth visit by calling the office and you will be given a time for our virtual visit.  You will receive an email confirming your appointment with instructions.  The email will be from “Telemedicine Service” with an email address that includes “modernizingmedicine.com.”  If you have not used my patient portal before, the first step will be to activate your access to the portal.

If you have used my patient portal before, use that ID and password to login to the “Pocket Patient” app.  It may ask you to change your password after you log in.  There is a “forgot password” feature if you can’t remember your password.  If you have difficulty resetting your password, call the office and we will help you.

Sign onto the app a few minutes before your appointment.  In the email confirmation you received, the “practice” listed (dermatologyboutique.ema.md) is what you will enter in the top box above your ID and password in the app, if it is not already filled in.

The sign on page of the iPhone app.

It is best to be ready for our e-visit by sitting in one position during our appointment.  This keeps the phone from moving around.

If I need to see a rash or skin lesion, sometimes it helps if a family member can hold the phone over the area.  When using a phone or iPad, the app allows you to switch between the front and rear camera on your device.  When using the rear camera, you can also use the phone’s flashlight to illuminate the area you are trying to show to me.

Remember that when you use the rear camera, it is usually in one corner of the phone.  Be sure the camera is over the area that I need to evaluate.

If you get disconnected during our visit, just log back into the app and re-join the call.

I’m looking forward to helping you with your skin issues during virtual visits.

If you have a more serious condition, such as a large cut that needs stitches or a painful cyst that needs to be drained, I am still doing in-person, office visits.  The idea is to keep you out of an urgent care or an emergency room where you could be exposed to COVID-19 patients seeking treatment.

Reveal Younger-Looking Skin!

· Lasers · Comments Off on Reveal Younger-Looking Skin!

Many of you know our friendly nurse, Franny.  She recently had a CO2 CoolPeel treatment that significantly reduced the wrinkles on her face and neck.

The CoolPeel laser helps with stubborn crows feet, lipstick lines, smile lines and pore size.  Most notably, CO2 improves wrinkles that cannot be corrected with fillers.

Franny was also one of the first to receive an Infini treatment, which does a great job of tightening skin.  Genius is the next generation of Infini.  Genius is an improved microneedling treatment with radio frequency.  It addresses sagging, crepey skin, turkey neck, jowls and large pores.  We upgraded to the Genius device last year.

If you have wrinkles along with loose, lax skin, this duo of treatments might do the trick.  Franny has had one CoolPeel and had 2 Infini treatments a couple of years ago.

When you’re in the office, feel free to ask Franny about her treatments and see her results in person!

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