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REGIONAL DERMATOLOGY
OF DURHAM

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REGIONAL DERMATOLOGY
OF DURHAM

Elizabeth H. Hamilton, MD, PhD
Amy Stein, MD
Julie Dodge, PA-C
4321 Medical Park Dr., #102
Durham, NC 27704
Telephone: (919) 220-7546 (SKIN)
www.dermatologydurham.com

The Pursuit Continues:
Protecting Healthy, Attractive Skin

Notes Dr. Amy Stein, of Regional Dermatology of Durham, “Over the years, steady and significant advances have been made in promoting rehabilitation and rejuvenation of the skin, on an as-needed basis. Our skin is the largest organ in our body and it needs consistent care and regular examination to keep it healthy and glowing.”

Dr. Stein offers her patient advice about caring for her skin in effective ways.

Fortunately, Dr. Stein and her colleagues offer a wealth of experience and dermatologic information and best practices on the care of the skin, for patients of all ages and with a great variety of skin conditions.

Number One:
Sun Protection

“No matter what kind of advancements are being made with different procedures and products,” says Dr. Stein, “the single most important thing I tell all my patients is to always use sunscreen when their skin is going to be exposed to the sun—no exceptions. It doesn’t matter what moisturizer or cosmetic product you use—and there are tons out there—you will negate any positive effect they claim if you don’t first cover up exposed skin with sunscreen each and every day. Your skin needs that protection.

“I also recommend to my sun-damaged patients—especially those who either have photosensitivity (sun sensitivity) disorders, and/or multiple skin cancers and pre-cancers—that they take a daily supplement. Heliocare is a product we recommend. It is extracted from the Polypodium leucotomos fern, found in the wilds of Central and South America. Its antioxidant properties help protect the skin against the aging effects of free radicals, thereby decreasing sun- related damage. It’s an oral supplement and can be purchased at your local pharmacy. By decreasing the likelihood of developing skin cancers or pre-cancers, Heliocare is an important supplement for anyone who is going to be exposed to significant amounts of sun exposure. But it is not a substitute for sunscreen; it should always be used in conjunction with sunscreen.”

Notes Dr. Stein, “Over the years, sunscreen products have definitely improved. When asked what is the best of them all, my answer is, ‘A sunscreen that you’re going to wear daily and one that helps prevent you from burning or tanning from the sun’s rays.’ It should include zinc oxide or titanium dioxide—a good UVA and UVB blocker combined. If a sunscreen is sticky, has uneven consistency, smells or burns—it’s not good for you. Which sunscreen to choose is a personal preference combined with proven effectiveness, on the individual level.”

Skin Care and Whole Health

Skin problems are much more than ‘skin deep,’ notes Dr. Stein. “They are often both symptoms of and responses to internal problems; and the patient’s response to skin issues can result in further difficulties. A couple of cases come to mind that illustrate this point.

“One patient was a middle-aged woman who came to us recently because she had very bad perioral dermatitis—an acne-like eruption often, but not only, see in adult females. Acne is a common—and treatable—skin problem; and we have a number of ways of treating it, depending on the patient’s needs. But this patient was so bothered by it that she started working from home instead of going into work. She was frequently tearful, and socially affected by this condition. The acne was only on her face, but everything is relative. Sometimes we may think that it’s just a few bumps and they’ll go away. But, to her, this condition was socially debilitating. She couldn’t understand why she would have facial acne in her 50s. It took us at least three to four months to find the right combination of different topical and oral medications that worked for her. But when we did, it was magic! After this successful treatment, she was a totally different, outgoing, happy person who felt so much better about herself. She went back to work and was emotionally revitalized because she finally felt comfortable and confident with her looks.

“On the other end of the spectrum, I saw a male patient—also in his 50s—who came in to see me for psoriasis. Unlike the acne patient, this gentleman was minimizing his symptoms. He had extensive psoriasis, which he had for quite some time but didn’t bother to have the condition examined and treated. Even more important when I finally saw him, his hands and feet were quite arthritically damaged. He either didn’t associate his symptoms at that point, or once again, he minimized the degree of his disease. After a few visits, he was willing to try a systemic medication. There are other problems, beyond skin issues, that can accompany uncontrolled psoriasis, such as cardiac risk, so the inflammation has to be reduced. In this case, this patient went from not being able to easily open and flex his hands, fingers, and toes, to playing golf shortly thereafter. He experienced a life-changing response to treatment. Sometimes people don’t realize how serious their condition is until they’re better and they no longer hurt.”

Pervasive Sun Damage

Notes Dr. Stein: “A majority of people tend to have a great deal of sun damage that eventually will produce tough leathery skin. Most of us—including yours truly—were blissfully unaware of skin issues growing up and as a consequence inflicted damage—some of it long-term—on our skin.

“As a consequence, we are frequently asked to help ‘rejuvenate’ our patients’ sun-damaged skin. Some people have only dark spots, others have spots and wrinkles. We have methods to improve a great many cosmetic challenges, so there really is hope now that a difficult issue can be significantly improved—or eliminated entirely. But reality is still an issue. If someone comes to us, say in their 80s or 90s, and they look like they’ve been out in the sun every single day, I’ll be very honest with them. I’m not going to say, ‘Put this cream on, it’s going to make you look much better.’  In fact, there’s only so much you can do for them.

“To promote and support rejuvenation,” she says, “we have different types of topical products, and we also achieve consistently positive results with Botox and fillers. Micro-needling and laser procedures also support rejuvenation. And there are also more extensive procedures such as laser skin resurfacing and a variety of surgical procedures. And it seems that a greater number of people are doing less invasive procedures now, because they’re busy, and they want less down time, and reduced risk of a less than desirable outcome.”

Repairing Scars

There are a number of options to treat acne scarring, explains Dr. Stein. “Microneedling can help many people. Skin Pen (the name of the product we use for microneedling) is a procedure that is done commonly in a series of three treatments. It’s a tool that you use to create micro injuries to the skin, promoting healing and increased collagen formation, while helping with texture, tone, and post-inflammatory pigment changes or scarring.

“For post-inflammatory acne changes, laser treatment can be very helpful. There are things we can do now that weren’t available years ago. If we see the patient early in the treatment phase, we can decrease the extent of the scarring problem. Options are much more limited after scarring damage has already been done.

“To maintain the health and appearance of our skin, I believe the very best option in today’s busy world is to care for ourselves both physically and emotionally,” Dr. Stein comments. “I can’t tell you how many things get worse in dermatology when we’re stressed-out or run-down. Perhaps for many this is easier said than done; however, I do believe skin rejuvenation needs to be considered from the standpoint of not only correcting the damage to our skin that has already been done, but engaging in practices to prevent future damage.”