Finally, with any skin condition, taking care of your overall health is essential.  Sleeping a full eight hours, eating a healthy diet rich in antioxidants (green tea, vitamin C, vitamin E, resveratrol, acai, blackberry, etc), exercise, and stress relieving activities (yoga, breathing) are vital to a youthful, energized, beautiful, you!

Halle Berry.  Michelle Pfeifer.  Megan Fox.  Chances are, when you hear these names, you think of the word beauty.  But what makes us label these women as beautiful?  Many people will say that symmetry is what makes people look beautiful.  To a certain extent, this is true.  Our eye is automatically drawn to what is abnormal, or "stands out" on someone's face.  An imperfection or asymmetry on one side of the face is often considered less appealing.  Think of Austin Powers, where Mike Myers can't stop focusing on the "moley moley moley mole."  Or when you have a large pimple on your face and you feel like everyone in the world is staring right at it.  But symmetry is not the whole answer.  If you cut a photo of someone's face in half and superimpose one half on the other, you'll see that even the most "beautiful" people's faces are not perfectly symmetric.  Conversely, if you computer generate a person with both sides of their face in perfect symmetry, they actually just look...wierd.

Often we consider certain features to be more attractive.  High cheekbones, wide eyes, full lips, white, even teeth.  But what about people whose features don't conform to that?  Think of Lauren Hutton's gap in her top teeth, or Angelina Jolie's large lips, or Brooke Shield's thick, heavy eyebrows.  All considered beautiful women.

So what else?  Proportion plays a large role in shaping our perception of beauty.  Dr. Stephen Marquardt talks about the "Golden Ratio," a certain proportion found in nature (1.618:1) that describes the proportions seen in the ideal, or beautiful face.  He says that this ratio is constant in beautiful faces, regardless of culture, race, or era.  The distance between the eyes, between the nose and the upper lip, and the size of the upper lip to the lower lip have all been measured and described as what is the "ideal" distance.

I personally think that the concept of beauty is too complicated to explain with a single number, or a single answer.  I think it's a combination of facial symmetry, facial volume, proportion of features, shape of individual features, clarity and texture of skin and hair, brights of the eyes, etc.  And one important feature that can't be changed with botox, fillers, lasers, or peels: personality!  

On Premier Dermatology, MD's facebook page, (like us!) Dr. Bilu Martin posted a photo of herself to show a spot on her cheek that she treated.  The spot is an actinic keratosis (AK), and they are quite commonly seen, especially in South Florida.  Aks debut as rough, scaly patches that are usually red, pink, or brownish.  They feel like sandpaper.  They can develop anywhere but are often found on the scalp (in men), cheeks, nose, lips, ears, backs of the hands, and chest.  Often, there are multiple Aks, in which case they are called actinic keratoses.  

These spots are PRE-cancerous.  They are caused by exposure to the sun.  A very low percentage of actinic keratoses, around 10%, may develop into a type of skin cancer called squamous cell carcinoma (SCC).  Squamous cell carcinomas can be removed in the dermatologist's office surgically.  

There are a variety of treatments for actinic keratoses.  They can be frozen with liquid nitrogen, either with a spray or a cotton-tipped applicator.  This will result in a red, crusty spot for a few days and then will resolve.  There are also topical medications, such as 5-fluorouracil, imiquimod, diclofenac, and ingenol mebutate that a dermatologist can prescribe.  These are applied to the Aks for a few weeks to months, depending on which cream is used.  They will almost often cause redness, crusting, and irritation to the area in which they are applied, which then goes away.  Sometimes a combination of freezing and creams are used.  Photodynamic therapy (PDT) is an in-office treatment that is also quite effective to treat AKs.

The best way to prevent the formation of actinic keratoses and skin cancer is to protect your skin from the sun.  Use a broad-spectrum sunblock.  Seek the shade.  Wear sun protective clothing.  And remember to have regular skin examinations.  Early detection and prevention is key!

It happens to millions of women and men.  It's so frequent, in fact, that there's a billion dollar industry of "solutions" to the problem.  We're talking hair loss, and it's no laughing matter.

Normally, our hair grows in a cycle.  When hairs are in their growth phase, they are called anagen hairs.  When they are resting (not growing), they are called telogen hairs.  Catagen hairs are transitioning from growth to rest.  Anagen hairs grow for about 3 years on average (the range can be between 2-6 years).  The transition phase lasts about 1-2 weeks, and then hairs rest for 3-5 months.  They shed, and the cycle starts all over again.  At any given time, if you pluck a number of hairs from the scalp, about 85% will be in the growth phase and 10-15% will be resting.  Less than 1% will be in the transition phase.  We can tell this by the shape of the hair and follicle when it's examined under the microscope.

It's normal to shed 100-150 hairs daily.  Think about it- that's a lot of hair.  And even more so on days that you shampoo.  But sometimes, that number increases, and the hair starts thinning or revealing bald patches.  So let's look at some reasons why people lose their hair.

Pregnancy.  During pregnancy, the anagen (growth) phase is often prolonged and many women enjoy thicker, fuller hair.  On delivery of the baby, however, many follicles change into the telogen phase, and then are shed simultaneously, resulting in thinning/loss of hair 3-5 months after baby comes.  This process is known as telogen effluvium.  And it's one more reason to give your mom a hug-- she brought you into this world and then endured hair loss!

Iron Deficiency.  Low iron levels (seen in a blood test), sometimes caused by mensturation or gastrointestinal blood loss, can also cause a telogen effluvium.  Nutritional deficiencies are often treated with vitamin supplements and a varied, healthy diet. 

Thyroid Deficiency.  Variations in thyroid levels can often cause telogen effluvium as well.  Levels can be checked with a simple blood test.  Thyroid medications, usually monitored by an endocrinologist (doctor who specializes in hormones) can help. 

Medications.  Lots of medications can cause hair loss.  Drug-induced telogen effluvium has been reported with amphetamines, blood pressure medications (captopril, metoprolol), antipsychotics (lithium), retinoids (etretinate), and more.  Changing/discontinuing medications can help.

Androgenetic alopecia is another term for male-pattern and female-pattern baldness.  In this condition, a hormone called dihydrotestosterone affects the androgen receptor gene to cause hair loss.  There is likely a genetic component.  Men tend to show a receeding hairline with loss of hair on the top of the scalp.  Women tend to get thinning along the middle part of the hair in a "Christmas tree pattern."  Several treatments are available, such as rogaine, and for men, finasteride (propecia) is FDA-approved. 

Other conditions that can lead to hair loss include fungal infections, autoimmune diseases (such as lupus or alopecia areata), psoriasis, bacterial infections, and syphilis.  Trauma to the hair from tight ponytails, frequent relaxer and hair color use, and overstyling can also lead to hair loss.

Often blood tests and scalp biopsies are useful to find the cause of the hair loss.  Dermatologists are expert in skin, nails, and hair, and can help!

A collective sigh of relief came across the country last week.  Parents everywhere are rejoicing that summer vacation has started - and for a little while, no homework, no scheduled activities, no rush.  And with one less thing to stress and worry about, everyone should now have clear skin. 

"What do you mean, Doc?" you may say.  "Stress can affect skin?"  You betcha!

When we're stressed, our bodies produce more of a hormone called cortisol.  We need that hormone in stressful situations- if we're in danger, about to be attacked, our body responds by saying "run!  escape!" and that cortisol kicks us into high gear.  But when constant low levels of cortisol are released, it is not a good thing. 

Stress can:

increase hair loss

make psoriasis worse

flare acne and rosacea

cause hives

precipitate a shingles outbreak

bring out cold sores

weaken the immune system, making it harder to fight infections

worsen eczema

lead to picking and pulling of skin/nails/hair

But there are ways to manage stress in our lives.  Exercising daily and eating a well balanced diet full of fruits, vegetables, and whole grains combats fatigue and stress, and increases energy levels.  Yoga, breathing exercises, and a few minutes of mediation daily help to lower cortisol levels.  Limiting alcohol and not smoking are important to keeping a healthy glow to the skin.  Spending time with family, friends, and pets builds connections and a strong emotional support system.  Hobbies, like gardening, or painting, are soothing and calming.  Find something you enjoy and look forward to, and make time for it.

And be stress-free.  At least, until school starts again!