Taking Pictures of Moles in Young Children

Support for the practice of following moles with pictures was published in the Journal of Pediatrics.

Spitz nevi, moles that needs to be differentiated from melanoma, were followed with clinical images and  dermoscopy. The conclusion was that particularly with younger children, typical Spitz nevi can be followed with sequential images and avoid surgery.

The following  editorial was published in Practice Update:

Evolution of Spitz Nevi:

Nazan Emiroglu , M.D.,* Pelin Yıldız, M.D.,† Dilek Biyik Ozkaya, M.D.,* Anıl Gulsel

Bahalı, M.D.,* Ozlem Su, M.D.,* and Nahide Onsun, M.D.* Pediatric Dermatology 1–8, 2017


Gary D. Lichten, M.D.

Seventy Spitz nevi were studied: 43 initially excised, 26 involuted, and 6 remained.

Twenty-seven were followed clinically and with dermoscopy images. The dermoscopy pattern, most frequently observed, was globular, followed by starburst. The age group was younger with the Spitz nevi that involuted: age14.3 (range 4.6 years), contrasted with mean age of the stable group was 19.0 (range 4.2 years). The range for involution of lesions was 21-27 months.

Although the number of cases were limited, the practice of following Spitz nevi in younger children with clinical and with dermoscopy images is laudable.  When viewing a suspicious pigmented lesion, because of the fear of missing a melanoma, we choose surgical removal as the first option. When given a choice, patients and parents frequently opt to be followed with photographs, and thus avoid a procedure and scar. With typical Spitz nevi in children as well as atypical nevi, I frequently follow nevi with dermoscopy images.

Although the authors followed Spitz nevi every 6 months, for atypical nevi, I use short-term, three month, monitoring.  Patients are engaged with taking and comparing images monthly with an application, with instructions to return immediately for excision if any change is noted.  Flat, atypical nevi, excluding those with any melanoma specific features ( atypical or negative network, irregular globes or streaks, blue-white colors, regression structures) are photographed with dermoscopy initially and again at 3 months.  I recommend the free application, CompariSkinFree,

CompariSkin, which enables patients to take consistent images and compare for changes with side-by-side and overlaid images within one minute.

Sequential dermoscopy images tell a story of change, which can be reassuring to the patient and parents for Spitz nevi, as well as atypical pigmented nevi.

Gary Lichten, M.D.

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.