We've all seen someone with it.  Or maybe you've got it yourself.  The dreaded cold sore on the corner of the lip.  It warns you it's coming with a tingling and burning feeling, then the painful blisters arrive and often outstay their welcome.  So what's the deal with these cold sores?  Where do they come from?

A virus called herpes simplex virus (HSV) is responsible for causing cold sores, also referred to as fever blisters.  It most commonly occurs in young adults, but can be seen at any age, including infancy.  Many people are infected with the virus and never develop cold sores.  Others may have sores but they aren't painful or symptomatic.  And yet others will have fever, headache, or pain associated with the blisters.

80-90% of herpes infections seen on the lips are caused by HSV type 1, and 10-20% are caused by HSV type 2.  Genital herpes is usually reversed, with 70-90% caused by HSV-2, and 10-30% caused by HSV-1.  But this is not a hard and fast rule; either type can be seen with lips or genitals.

So how is this virus spread?  Usually skin-skin contact is required.  The virus is shed in skin or secretions.  When herpes is seen in wrestlers due to skin-to-skin contact, it's called herpes gladiatorum, and is more common on the head, neck, or shoulder.

Unfortunately, once you've contracted HSV, it's there for life.  (So what happens in Vegas doesn't always stay in Vegas...).  It stays dormant in the nerves and gets reactivated later on.  About 1/3 of people with cold sores on the lips will have a recurrence.  And of these, 1/2 will have at least two recurrences annually.  Usually there is a precipitating factor to bring it out: sunburns/sun exposure, fevers/colds, stress, and altered hormones. 

Before we discuss treatment, let's talk prevention.  Avoid skin-to-skin contact with an area during an outbreak.  The outbreaks are usually treated with oral antiviral medications such as acyclovir, valcyclovir (valtrex), or famciclovir.  If the outbreaks are very frequent, daily suppressive therapy may be used.  There are topical presciption creams, as well, but they are typically not as effective as the pills.  The medications work best if they're used as soon as the tingling/burning feeling comes on.  Although there's no cure, with today's treatments, the discomfort can be minimized and sometimes prevented.

Children are so wonderful, aren't they?  They truly light up our lives with their shining eyes and smiling faces.  So wonderful, in fact, that we can almost overlook the changes they cause to our bodies.  Loose, sagging skin, stretch marks, and little winding leg veins are a small price to pay for the glory of motherhood, right?  Um, right?

Thankfully, we can improve those (ahem) little issues that occur after the little munchkin is born.  Let's talk about sclerotherapy, which is a procedure performed in the office for small varicose veins on the legs.  After all, this is sizzling south florida, where the dress code is: the less on, the better!

Sclerotherapy involves injecting solutions into varicose veins to "close the veins down."  They do this by irritating or damaging the lining of the veins enough to form a small clot, which over time, will be replaced by tissue.  Different agents are injected to acheive this, including: hypertonic saline, sodium tetradecyl sulfate (STS), polidocanol, and glycerin.  Currently, STS and polidocanol (Asclera) are FDA approved for the treatment.  Which solution to use depends on the physician's preference and the size of the vein being injected.

The treatment session usually lasts 30 min-45 min.  There very minimal discomfort during the procedure, which is often dependent on which solution is injected.  At pdmd, we favor Asclera, as it is easily tolerated with no downtime.  Compression stockings are sometimes worn after the treatment.  Usually, 2-3 sessions are recommended for best results, but veins will improve even after the first treatment.  Pregnant or nursing women should not have sclerotherapy.

Having kids doesn't mean you're destined to hide your legs for the rest of your life!

It's a new year.  Time to detox, reflect, and re-new.  Many of us make the most common resolutions, such as working out/losing weight, saving money, and working harder.  Even though we start out strong in January (check out how many people are at the gym this week), resolve can wane by mid-March.  Here are a few resolutions that you actually may enjoy keeping!

Resolution # 1: Drink More Coffee

Hello, Starbucks.  Women who drink three cups of caffeinated coffee a day can reduce their risk of basal cell carcinoma by up to 20 percent, compared to those drinking less than a cup monthly.  These results are based on a large population study: over 113,000 adults who took part in the U.S. Nurses' Health Study and Health Professionals Follow-Up Study. A lesser decrease in risk was seen among coffee-drinking men.

Resolution #2: Drink Red Wine

This is not permission to finish a bottle of malbec (sorry!).  A small glass of red wine a day contains resveratrol, which is a potent antioxidant found in grapes.  Antioxidants fight free radicals in our skin and body, which are harmful and play a role in skin cancer and aging.  A moderate amount of alcohol has also been found to be heart-healthy and raises levels of "good" cholesterol, or HDL.  Of course, women who are pregnant/nursing or those with medical conditions should not drink alcohol. 

Resolution #3: Eat Dark Chocolate

In a recent study, German researchers gave 24 women a half-cup of cocoa enriched with flavonoids daily. After three months, the women's skin was better protected, less red, and had a smooth appearance after exposure to ultraviolet light. The researchers think the flavonoids, which absorb UV light, help protect and increase blood flow to the skin, improving its appearance.  Plus dark chocolate contains more of those good antioxidants!

Resolution #4: Wear Your Sunscreen

I have to throw this one in: I've said it before and I'll say it again: sunscreen, sunscreen, sunscreen to prevent skin cancer and the signs of aging.  Okay, lecture over.

Happy 2015 and here's to a year of great health and gorgeous skin!

Reward programs. Seems like everywhere you look, companies want to reward you. Buy 10, get 1 free sandwiches. Free gas with groceries bought. Fly enough, and a free flight will come your way. Use your credit card, get cash back.  And the latest in rewards? Beauty bucks. Take advantage of Allergan's Brilliant Distinctions program. With every Botox, Juvederm, Voluma, and Latisse purchase, receive points that translate into money off your next treatment. A reward for keeping yourself rejuvenated? Pretty brilliant, indeed.

And for the holidays: Allergan has the Brilliant Distinctions mall. 

Log into the Brilliant Distinctions home page and access the mall, which has hundreds of stores that many of us online shop at on regular basis: DSW, Piperlime, Tory Burch, Target, etc.  Shop for your holiday gifts, and for each dollar amount spent, you will earn points that can then be redeemed for rebates on Botox, Juvederm, and Latisse!  Additionally, points can be issued in the office when SkinMedica products are purchased.  We carry many SkinMedica products at Premier Dermatology, MD (Lytera, Retinol complex, Redness relief, AHA/BHA cream), so earning points is an added bonus.  Happy Holidays and happy shopping!

Acne scars are common and can be very emotionally distressing.  They can be improved with a variety of methods, including subcision (manually breaking up the scars with a needle), lasers, peels, and injection of fillers.  One filler that works particularly well in this condition is silicone.

The use of silicone has been controversial due to the injection of illegal silicone substances by both physicians and non-physicians.  The only silicone that should ever be used is a sterile and highly purified medical grade liquid silicone oil, such as Silikon 1000®.  This product is currently approved by the FDA for the treatment of retinal detachment.  Dermatologists and plastic surgeons have used it for decades "off-label" to correct lines, wrinkles, and scarring.  It is a safe treatment. 

Silicone is permanent.  In order to avoid lumps and overcorrection, silicone is injected using the microdroplet technique.  Very tiny droplets of silicone are injected with the smallest needle.  The silicone stimulates collagen to form around the droplet, allowing the scar to become filled in and smoothed out.  Because small amounts are injected at a time, several sessions are scheduled monthly.  The scars will not be fully corrected after the first treatment.  Doing it this way results in a natural appearance.

It's important to seek a licensed, board certified dermatologist with expertise in the use of silicone and its potential complications. They must use the medical-grade Silikon 1000 and the microdroplet technique, the only substance and technique used at Premier Dermatology, MD.