Selfies that matter

Selfies matter.

We take many selfies, but have you considered snapping a few pictures of your skin and moles to keep as a reference?

Taking pictures of your skin provides valuable information: if a mole is changing, a biopsy is frequently indicated. If not, and the appearance is not convincing for malignancy, why biopsy?

Recently, I saw a patient for whom I suggested monitoring her moles with  photographs. Upon returning after three months, the patient stated assuredly that the mole on her shoulder had not changed.  When I compared the moles with side-by-side pictures, the mole had changed and the biopsy revealed an evolving melanoma that required additional surgery to ensure complete removal.

I welcome pictures from patients. The photo not only provides information on how it looked, but also enables me to deduce whether change has occurred. One photo affects my decision-making process.

Additionally this month, I saw a young mother who had an infection on her face. She visited a stat-care facility on the day before and received antibiotics. When I looked at her pictures, I knew that her therapy was working and she did not require any change in therapy. That change would have been antibiotics administered at the hospital for her cellulitis, a serious skin infection.

I have made these decisions with the use of one photograph:

  1. Obtaining a biopsy of a changing mole: most proven to be cancerous or premalignant
  2. Avoiding a biopsy
  3. Confirming the site of a previous biopsy before surgery
  4.  Altering treatment
  5.  Avoiding blood tests
  6. Determining the efficacy of procedures and skincare regimens

 

Having a photograph as a record enables you and your doctor with the decision making process.  Especially today, with the frustrations of navigating the healthcare system, anything that you can do to take charge, advocate for your health, and be empowered, can affect outcome. Having a record of your moles in an organized way helps alleviate some of the frustrations. Understanding the needs of the patient, along with the importance of monitoring skin and moles for change, motivated the development of the application CompariSkin, with its’ innovative software.

CompariSkin was created to help patients track their skin and moles for change, or mole mapping.

Research has proven that mole mapping detects skin cancer earlier and reduces unnecessary biopsies.

One in five Americans will develop skin cancer (4,000,000 per year). The growth rate of melanoma, the deadliest of skin cancers, continues to increase. One person dies every hour from melanoma (79,800 cases per year).

Although mole mapping is performed at most major teaching health centers, the procedure is rarely performed in the doctor’s office. Several estimates state that than fewer than 5% of dermatologists perform mole mapping.  Today’s technology assists you with mapping your skin. The objective is to detect changes sooner, which could indicate skin cancer, as well as to minimize unnecessary biopsies, surgeries, scars, and expense. Furthermore, instead of wondering whether a mole has changed, it can be reassuring to look at a photograph.

Did you know that radiologists compare prior xrays and universally comment on any change in their report? Why is this practice of comparing pictures not being performed by more physicians? I am disappointed that our electronic medical records  lack organization  when viewing and comparing photographs.

The application is unique and the most thorough application because you use reproducible 3D imaging with side-by-side, and overlaid images. These features provide consistency  to objectively judge change. The program allows you to compare, both skin zones and close-ups, in the most thorough, organized way.

Who should be mapped?

Have you had a biopsy that was unnecessary?

Do you have a birthmark or congenital nevi, personal or family history of melanoma or atypical or dysplastic moles? Do you have greater than 20 moles on a leg or 11 on the right arm or over 50 total, history of tanning beds, two or more sunburns, fair skin, green or blue eyes or blond or red hair? Are you immunosuppressed? Have you had skin cancer? With a history of one basal cell or squamous cell skin cancer, there is a 45% chance for another.

Do you wonder whether your procedures and skincare are delivering expected results? The answer is clear with viewing side-by-side, before and after pictures.

The signs of skin cancer can be a new mole, a bleeding spot, or an itching growth. Most melanomas develop new, not from a preexisting mole, after the age forty.

The ABCDEs of melanoma:

A (symmetry)

B (border)

C (color variegated)

D (diameter greater than a Pencil eraser)

E (evolution)

E, for change, is the most important sign. That is why monitoring your moles is so important: any detected change warrants a visit to your doctor to determine whether skin cancer is developing and whether to surgically to remove the growth. If your doctor finds a suspicious mole, he or she may suggest short term monitoring of one body area for three to four months. If you detect any change, prompt and complete removal of the mole is indicated.

Simply snapping a picture of your skin enables you to tell a story of change and to provide information that can be critical for the decision-making process. Furthermore, the app assists with record keeping by enabling you to see reports and the location of any surgery.

While no application can replace a visit to your doctor, taking charge of your health can affect the outcome.

Advocate for your health.

Download the most thorough and innovative skin application, CompariSkin, today, and start taking selfies that really matter.

 

Gary Lichten, M.D.

gary@CompariSkin.com

Why does my dry skin and eczema flare now?

Dry skin and eczema flare at this time of year.  Dry skin occurs naturally as we age. The dryness and coldness of the winter air further irritates our skin and leads to embarrassing scratching.  Furthermore, applying the incorrect cream or ointment may cause allergies or sensitization, which causes inflammation, redness, and itching. The scratch-itch cycle is amplified insofar that the skin becomes thickened, cracked, or weepy with infection, thus interfering with sleep and other everyday activities.

People, especially children, who have atopic eczema – the common hereditary condition associated with the family history of asthma, hay fever, or eczema – are particularly affected in the winter. The skin serves as a barrier to retain moisture: when impaired, as with atopic eczema or aging, dryness and itching occurs.

Mothers of young children, nurses, along with others, who are exposed to water, frequently experience dry skin, eczema, or dermatitis.

Treating dry skin or eczema begins with moisturizers. Applying  moisturizers within three minutes after a quick, non-hot shower or after washing hands maximizes benefit. There are many moisturizers available today. I frequently recommend Eucerin, Aveeno, Cetaphil, CeraVe, Vanicream, and Ammonium lactate.

Soap is an irritant and should be restricted to the parts where needed the most: under the arms and groin.

Liquid, fragrance free soaps with moisturizers, when used sparingly, are beneficial.  For hand dermatitis, hand sanitizers are generally preferable over soap. Exposure to water must be minimized. I like cotton gloves for non-wet household chores: keeping your hands clean enables the avoidance of additional hand washing. When washing dishes, place vinyl gloves, over cotton gloves, to minimize sweating.  Moisturize immediately after removing the gloves.

Topical steroids, both over-the-counter and prescription, are frequently needed when moisturizers alone are not working. Applying moisturizers over the steroids works best.

Prescription tacrolimus is an alternative to topical steroids.

Other treatments include antihistamines, enhanced moisturizers, and antibiotics. Crisaborole, a new gel for children, (over 2 years) and adults affected with atopic eczema, is expected to be released January 2017.  Additionally, individuals who do not respond to conservative measures, targeted immunotherapy, dupilumab, will be available soon.

Dry skin and eczema may be much more than a daily annoyance: interfering with daily activity, loss of sleep, and embarrassing scratching. Although for most patients, effective therapies exist today, I enthusiastically look forward to using the new classes of medication to help patients.

Gary Lichten, M.D.

gary@CompariSkin.com

Why are my lips sore?

fblipsRecently, a young woman complained of sore lips and a rash on her chin. Her doctors treated her with antibiotics and creams for five years without improvement. Upon examination, I saw redness on the sides of her chin and her lips were dry and cracked. Upon further questioning, she revealed that she chose products with cinnamon in her toothpaste, chewing gum, candies and pastries.

Based on her history and clinical findings, my impression was contact dermatitis to cinnamic aldehyde. Cinnamon, as well other flavors and fragrances, contain the compound. Decades ago, the widespread use of cinnamon toothpicks lead to the recognition of contact dermatitis. I recommended the use of fragrant free baking soda toothpaste, and the avoidance of any compounds with flavors and fragrances, as mouthwash, candies, chocolates, and ice cream.

Chapness occur more frequently than contact dermatitis of the lips . People experience chapped lips, either from lip licking or mouth breathing. Allergic individuals, who have atopic eczema, upper respiratory asthma or sinus problems, frequently mouth breathe and lick their lips. Lip balm, lip conditioner, or Acquaphor is helpful to control the sore lips.

Additionally, cracking in the corners of the mouth, called angular cheilits or perleche, causes lip irritation.  The derivation of perleche comes from french, meaning “to lick”. Gravity lowers the corners of the mouth and thus facilitates a moist environment, whereby yeast infections develop. Licking the corners of the mouth, poorly fitting dentures, and vitamin deficiencies, including niacin, vitamin B12, folate, and zinc, can cause cracks in the corners of the mouth.

Also, ultraviolet light damages lips and causes soreness with  precancerous changes or actinic chelitis. Smoking frequency causes leukoplakia or precancerous changes as well. The lips appear white, mottled, crusted, or with cracks. These pre-cancerous conditions require SPF30 lip balm protection and prescribed therapy to reverse the changes. Therapies recommended include creams, photodynamic therapy, and laser.
When left untreated, squamous cell skin cancer of the lip may develop and has the potential to metastasize and even lead to death.
Furthermore, cold sores or herpes simplex infections, lichen planus, and autoimmune conditions  cause sore lips.

Multiple conditions contribute to lip soreness. If Aquaphor,  lip balm, or lip conditioner does not improve the condition, a visit to your doctor is worthwhile.

Gary@CompariSkin.com

What Skincare Products should I use?

Retinoic acid. Retinol. Retinaldehyde. Copper peptides. Palmitoyl Oligopeptide. Palmitoyl tetrapeptide-7. Hyaluronic acid. Alpha & Beta hydroxy acids. Antioxidants. Vitamin C & E. Niacinamide. Botanicals. Botox cream.

There are hundreds and hundreds of choices for skincare products with thousands of different ingredients which promise to make us look younger, have fewer wrinkles and brown spots, and have a youthful glow. What really works?

Cosmeceuticals are over the counter skincare products  that contain chemicals which can reduce the signs of aging. These products, unlike medications, are not approved by the FDA. For some products, there may be scientific studies, but not the rigorous testing that pharmaceutical agents must pass before approval.

How does one accurately determine which skincare products to buy and whether the products are effective?

As a dermatologist, I enjoy reviewing the scientific evidence. I then compare results by overlaying images using CompariSkin.

My skincare recommendations are as follows:

1. Sunscreen

2. Sunscreen

3. Sunscreen

4. Retinoic acid and/or Peptides

5. Moisturizers, which smooth and soften the skin, are available in most sunscreens and other cosmeceuticals. I recommend their usage over  retinoic acid for those with constant dry skin.

Sunscreen is at the top of my list as one needs to look no further than your mirror or take a picture to compare your left and right side to see the effects of UV light. Which side has more wrinkles? More brown spots?

90% of the changes seen with aging are sun related. The changes range from wrinkles, brown spots, and mottled coarse skin to severe skin cancer. More skin cancer occurs on the left side from the ultraviolet light passing through the car window glass. Applying a broad spectrum SPF30 sunscreen daily is the most important part of any  regimen. Studies confirm that there is a 50% reduction of precancerous spots or actinic keratoses with the daily application of sunscreen.

After sunscreen, Retinoic acid (Retin A) has substantial scientific data proving its’ efficacy for skin roughness, mottled hyperpigmentation, fine lines, and wrinkles. Retinoic acid or Retin A has been available for decades and has more studies than others to prove its’ efficacy.

Prescription retinoic acid, when tolerated, still remains the favored  anti-aging product with the effectiveness proportionate to strength. The prescription has become expensive. Today hundreds of over-the-counter cosmeceuticals contain retinol derivatives.  Retinal aldehyde (RAL) and retinol (ROL) are the most effective, but the concentration must be at least .025%.   The .1% cream is more effective, but can be drying and irritating to the skin. Other retinoids, as retinyl palmitate and retinyl-acetate are not significantly effective.

Additional products that  are beneficial for deep and superficial wrinkles are peptides.

The peptides, which are chains of amino acids, are critical for protein development. They moisturize and generate Collagen I, II, & VII, elastin, and hyaluronic acid.  Objectively, I have seen wrinkles soften over thirty percent, even in an 89 year old. Many peptides occur naturally, and the cosmetic companies are creating new peptides synthetically as well.  Palmitoyl oligopeptide and Palmitoyl Tripeptide-21 have proven effective, and many others exist.

Begin with a peptide that meets your budget, that is well tolerated, and that fulfills your realistic expectations. If you can begin with a sample, even better.

Layering several products may diminish each one’s effectiveness. With multiple choices, I frequently use the split face approach: one on each side, or different products morning and night. Applying the skincare product as directed, for the recommended  time, provides the true efficacy.

I am looking forward to observing results with the new botox cream as well future compounds. To what degree can our complexions and wrinkles be improved?

Snapping images with close-ups, for side-by-side comparison using compariskin:wrinkle compareCompariSkin, provides the best objective evidence. Using medical technology for evaluating progress can be cost-effective, educational, and fun!

Gary Lichten, M.D.

gary@ CompariSkin.com

Rarely Recognized Summer Maladies

Poison ivy. Fungus infection. Sunburn. These conditions are common in the summer, but recently I saw an interesting condition that is rarely recognized.

This middle aged woman presented with a history of a reddened, swollen, weeping dermatitis on her face that had occurred repeatedly. Only thorough, repeated questioning could I elicit from her that she had been using a citrus perfume spray.

Citrus products, including lemons, limes and bergamot oranges along with carrots, celery, parsnip and figs may cause this hypersensitivity to the sun or phytophotodermatitis. The chemical reaction from these plants reacts with the ultraviolet light producing a rash and pigmentation. All that is necessary is to remove the offending agent and use sunscreen so that the pigmentation will fade with time.

It is of historical significance that the Egyptians used figs with its’ furocoumarin compounds to treat vitiligo, a condition which causes loss of pigment.  Michael Jackson was afflicted with this disorder.

Along with topical medication reacting to the sun, be aware than many oral medications may cause you to sunburn or in some cases react with the sun and leave pigmentation. The list is long, but includes commonly used antibiotics, diuretics, and antiinflammatory drugs. Medication that alters your immune system as immunosuppressants and biologicals increase your risk for skin cancer, so limiting exposure and using sunscreen is strongly recommended.

Poison ivy is common but did you know that many of the over-the-counter products used to treat the poison ivy can cause an allergic reaction as well?
poison ivyThe topical ‘dryls’, ‘caines’ or ‘sporins’ are known allergens that can potentially produce a rash similar to poison ivy and exacerbate the condition. Early poison ivy or rhus dermatitis is best treated with cool compresses to dry the blisters. Over the counter hydrocortisone may help, but when more severe seeing your physician is recommended.

Many other plants, trees and even roots can cause a dermatitis, and therefore it is recommended to cover up, wear gloves, and wash thoroughly after gardening.

All that summer sweat aggravates many skin conditions, including acne, folliculitis, athlete’s foot and rashes in the folds.

I have found the simple steps of using an over-the-counter salicylic acid 2% pad before or after activity along with blow drying the area can be beneficial. The cool blow drying assures that the area is dry, as moisture promotes the growth of organisms that creates the infection. Prescription medication is helpful with more resistant cases.

I would be remiss if I did not mention sunscreen.

Some people react to some of the active agents in chemical sunscreen, so it is always a good idea to test the product in one spot for a few days before using.

If an allergic reaction occurs, using a physical sunscreen with zinc oxide or titanium dioxide may be helpful, along with a UV shirt, hat, and sunglasses.

Using a daily broad spectrum SPF 30 sunscreen daily has been proven to reduce skin cancer and those familiar signs of aging: wrinkles, brown spots and mottled pigmented skin.

The biggest problem is that most often not enough sunscreen is applied: a golf ball size amount covers an adult. To be effective, sprays needs to be sprayed three times and rubbed in after each application.

If you must have color, try the tanning lotions or a spray tan: the products have become so effective that even to this dermatologist’s trained eye, they look realistic.

Enjoy the summer, but be aware of all that the sun can do.

Gary Lichten M.D.

gary@CompariSkin.com

Embracing Medical Technology

Recently I read Joseph Kvedar’s book, The Internet of Healthy Things, in which he writes about the “seismic” change in medicine. He paints a vivid picture with multiple examples and studies with the profound affect that is presently occurring in healthcare.

Why have we been so slow to embrace medical technology?  Technology can improve our lives, health, promote convenience and even save money and time. Medicine is only now beginning to take a lesson from other industries, such as retail, travel, and entertainment that use cookies to learn about our habits and preferences.

The delay with the medical field lies with doctors as well as the consumers. Physicians are slow to change habits and only often react when forced through insurance providers, government and hospital regulations. This change has been long overdue: the system is too expensive with one out of every five dollars spent by the government for healthcare totaling $3 trillion (one trillion is wasted!).  The recent explosion in cost is primarily due to The Affordable Care Act and the expansion of programs. You can see the early affect with the physician and the mandatory use of computers (or incurring penalties) with these programs: every visit the doctor is looking at his computer, not you, the patient!

The consumer has embraced health sensors and fitness monitors, but has been reluctant to accept medical technology.

The vehicle for facilitating technology is here: two-thirds of U.S. population use smartphones.The average user of a smart phone looks at the screen 150 times per day and may download a medical application, but rarely uses it after the initial week.

But now, with insurance premiums and deductibles skyrocketing into the thousands of dollars, the consumer has begun accepting medical technology and questioning whether every test ordered is necessary.

A primary example is in my field of dermatology.

The average biopsy and pathology report cost between $250 and $500 with a surgical excision easily over $1000.
Monitoring a mole with smart phone images that can be compared side-by-side or overlaid to detect early changes, not only spares the expense of the procedure, but avoids an unnecessary scar.

Additionally, incorporating the application into one’s lifestyle, as with cosmeceutical skincare, encourages the user to embrace the technology in a fun way: comparing sequential images for change allows the user to determine whether the product is delivering the results promised. Before and after pictures provide immediate feedback to see whether the products meet your expectations.

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In the future, your images could be uploaded, analyzed and provide results using artificial intelligence. Reminders, which are currently available on the app, provides messages to check your moles and schedule a visit with your doctor. The combination of predictive analytics with genomics will make personalization possible and revolutionize health care soon.

Embracing medical technology may be intimidating at first, but the convenience, improved care and cost savings will be beneficial to all.

CompariSkin with innovative technology, allows you to begin today to embrace medical technology and be empowered for better health.

Gary Lichten, M.D.

 

 

Zero to One Hundred

No matter how many moles. Caucasian African-American Hispanic or Japanese does not matter, you are at risk for skin cancer.

Count your moles.

If you have a total exceeding 50 moles you have an increased risk of skin cancer. Even more than 20 moles on a leg or 11 moles on your right arm there is an increased incidence.

When you have a precancerous mole or atypical or dysplastic mole the odds of developing melanoma increases significantly.

Dysplastic or atypical moles are benign, but can resemble melanoma for the larger size and irregularity of the edges or color.

dysplastic

Do you have any moles that are different from others? Larger than a pencil eraser? Irregular edges? Color that is variegated: not homogeneous throughout?

People with atypical moles occur in 10% of the population.  Especially those who have family members with the atypical mole syndrome have a 7 to 27% increased risk for melanoma.

The risk approaches 100% for individuals who have the atypical mole syndrome with two first-degree relatives ( as a mother and sister) who have had a melanoma.

Any new mole after 40, especially those that do not have any moles, can signal a melanoma.  Most, but not all, melanomas arise as new, not from preexisting moles.

All races develop skin cancer. 90% occur with Caucasians, but darkly skinned individuals, especially those with prolonged UV exposure can develop skin cancer. The palms and soles are the locations where dark skinned individual’s melanoma frequently occur.

Consider these statistics:

*One in five Americans get skin cancer

*One person dies every hour from melanoma

*One person is diagnosed every 8 minutes with melanoma

*Over 4 million cases of skin cancer yearly

*One blistering sunburn increases the risk of skin cancer

*10 or more visits to a tanning booth has an increased risk for melanoma

*Between 40-50% of people older than 65 will develop skin cancer

No matter how many moles. No matter what race or ethnicity. You are at risk for skin cancer.

Be smart, get checked by your doctor and then perform self exams and mole map to detect changes which can assist with early detection of skin cancer.

Gary Lichten, M.D.

gary@CompariSkin.com

Are you at risk for skin cancer?

Are you at risk for skin cancer?

Discovering skin cancer early improves outcome: both cosmetically as well as prognostically.

Consider these statistics:

*One in five Americans develops skin cancer: over 4 million cases a year

*One person develops melanoma every eight minutes.

*One person dies every hour of melanoma.

Risk factors for skin cancer include genetic and environmental.

Genetic:

*Blond or red hair with blue or green eyes and freckling

*Family history of melanoma or pancreatic cancer

*Prior history of melanoma, as there is an increased risk for others to develop

*Family or personal history of atypical moles (multiple large and small moles or dysplastic)

*Individuals with over 100 moles.  Evidence supports an increased risk if you have 20 or more moles on the legs or 11 or more on your right arm.

Environmental:

*Prolonged ultraviolet exposure

*One blistering sunburn

*Ten or more visits to a tanning booth increases risk for melanoma

*Immunosuppressed individuals including transplants, on biologicals or chemotherapy

What does melanoma, the most dangerous of skin cancers, look like?

  1. Asymmetry: the mole is not symmetric as the two halves do not match
  2. Border: the border is irregular
  3. Color: the color is not the same throughout. There is variegation of color or black dots
  4. Diameter: larger than 5 millimeters or a pencil eraser
  5. Evolution: the mole is changing

Of all the features, ‘E’, a changing mole is the most important sign. Changing can be difficult to detect, so sequential photos and comparing side by side and overlaid are helpful

Other features that require attention:

*New mole: any mole occurring after the age of forty2005-05-24a_0070-1

*Ugly duckling mole: a mole that is totally different from others by either size or color

*Pink mole (see pink, stop and think)

*Painful or itchy mole

High risk individuals should be checked at least yearly by your physician with monthly self exams.  Mole mapping or total body photography has been shown to detect melanoma earlier and reduce the number of biopsies.

Being an advocate for your health can and will make a significant difference.

Gary Lichten, M.D.

downloadbeacha

Why CompariSkin?

Why CompariSkin?

Taking a picture of a mole to see whether it has changed is not as effective as comparing two images side-by-side or overlaid.

CompariSkin is the only app that provides side-by-side and overlaid imaging.

Are you at high risk for skin cancer?
Do you have a scar from an unnecessary biopsy?

* One in five Americans develop skin cancer.
* One person dies every hour of melanoma.
* One person is diagnosed with melanoma every eight minutes
* 65% of new skin cancers are detected by the patient and their partner.
* 90% of biopsies may not be necessary

High-risk individuals predisposed to develop skin cancer include those with just one blistering sunburn, 10 or more visits to a tanning bed, family history of melanoma or pancreatic cancer, history of atypical mole syndrome and immunosuppressed individuals.

Taking a picture of a mole to see whether it has changed is not as effective as comparing two images side-by-side or overlaid. Recently I saw a patient who had a mole that was to be followed with photography. The patient opted to take a photograph, without CompariSkin.
When seen in follow-up she stated that it was had not changed but when compared with side-by-side images, it had indeed changed and was evolving into an early melanoma. Mole mapping has been shown to detect melanoma earlier. Side by side and overlaid images facilitate recognition of early changes.

A recent multi-institutional study has proven that mole mapping reduces the number of biopsies. Major health centers may perform mole mapping, but relatively few dermatologists in private practice perform this service.
If the image of the mole has not changed and the physician does not see distinct abnormal dermascopic features, why biopsy the growth and leave a scar?  Additionally, knowing that medical errors occur, wrong site biopsies can be avoided with a picture. Preventable medical errors is the number 3 killer in the United States: 400,000 people per year die each year. Taking charge and advocating for yourself can make huge difference.

Other features that make CompariSkin thorough and unique include the use of hologram images that allow reproducibility, examining close-ups with just one click, reminders, charting results and email capability to share photos with your physician.
While CompariSkin is intended to assist you with your skin health, it does not replace a dermascopic exam with your physician.

CompariSkin: A digital map to healthier skin.

Gary Lichten, M.D.