Picker, Popper, Peeler…

Dr. Kingslea Moore, Family Nurse Practitioner

I find myself on a daily basis telling patients to “stop scratching”, “stop picking, “stop popping”, and “stop peeling”. Many patient encounters include how to avoid scratching, and how to reduce the compulsion to pick or pop. My interest in Dermatology is partially because I myself find satisfaction in picking! My inspiration for this blog post is how to address this skin abuse, and treat ourselves with love and healing.

The medical term used to describe skin picking disorders is Dermatillomania. Skin picking is a nervous or anxiety related disorder that is also referred to as Skin picking disorder or SPD. Quite often the habitual picking begins with understandable circumstances. Perhaps a blemish is the target of the picking, such as an ingrown hair, insect bite, a minor imperfection, and is often temporary. For some reason, we develop an irresistible urge to pick this minor imperfection to the point of pain and destruction. The original picking creates a bigger target area on which to focus attention, thus picking, so the habit becomes self-perpetuating.

Why is picking such a problem? Although one may have clean and washed hands, the nail beds, nail polish, and fake nails are notorious for harboring bacteria that is not easily washed off by common hand washing techniques. Inflammation and subsequently scar tissue also develop when we rupture and disrupt the skin’s surface. With the skin being the body’s largest organ, we want it to be well cared for.

The American Academy of Dermatology recommends that patients whom excessively pick should be either co-managed by a mental health specialist and dermatologist, or managed by a specialist who has experience in both psychiatric and dermatologic disorder.

I believe with a little conscious skin love and self control we can curb our urge to disrupt the skin barrier. 

  • Using the appropriate lotions to encourage soothing touch of the skin
  • Cover the area  with long sleeves, pants, or bandaids
  • Meditate on the impulse to pick, if comfortable while sitting on your hands. Some yogis say you “burn away Karma” when you resist an unhealthy compulsion.  OKAY… this might be a little out there for some people…
  • Try to always touch your physical body with compassion and awareness…
  • Redirecting your attention by taking a walk, draw, write, play an instrument, or clean the house
  • Playing with bubble wrap can give the same tactile sensation of popping pimples
  • Forgive yourself immediately if you do pick. The shame of being imperfect can often lead to more shame of being “out of control” when we pick.

van gogh


Park, K. Koo, J. (2014). Skin picking disorder. UpToDate. Accessed 08 Oct 2014 http://www.uptodate.com/contents/skin-picking-disordersource=machineLearning&search=Dermatillomania&selectedTitle=1%7E1&sectionRank=2&anchor=H15211858#H15211858



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Bio-identical Testosterone therapy – will it protect me or give me a heart attack?

iStock_000013751074SmallThis article is a reprint of a post from Sajune Institute for Restorative and Regenerative Medicine:

The most common comments we hear from men on testosterone are, “I got my life back!” “My energy is great!” “My sex drive is back.” “I’m building muscle.” “I got off of Lipitor.” “My diabetes is under control.” Although, more than 30 credible studies show the benefits of optimal testosterone levels, two studies released early this year reported an increase in heart attacks with testosterone therapy. These studies made the headlines just as the medical community began their analysis. The reanalysis of the data showed “gross mismanagement of data”, the accidental inclusion of women and several other flaws that resulted in a request for a formal retraction of the study by Harvard professor Dr. Morgantaler, 29 medical societies and 9 journal editors. The good news is that most studies show that testosterone levels restored into the upper ranges is associated with protection against heart attacks, strokes, Alzheimer’s, arthritis, diabetes, high cholesterol and muscle loss.

At age 50, testosterone levels have declined by approximately 50 percent. This decline is accompanied by symptoms and disease. A review of the current literature on disease and quality of life supports the most common statement we hear, “I got my life back!”

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The Benefits of Eating an Alkaline Diet: PART I


Healthy Skin – A True Balancing Act

We’ve all heard a lot of hype about it, but what is an alkaline diet?  To begin with, pH measures the amount of acid or alkaline present. Our blood pH is slightly alkaline at 7.35 to 7.45. Our body depends on a tightly controlled pH level to survive. Luckily, the human body maintains this level naturally. However we can make the body function more efficiently and with less stress by eating foods, which promote alkalinity in the body.  When we maintain alkalinity, we detoxify naturally through our bowels and kidneys and we keep minerals in our blood and in our bones where we need them to sustain energy and vitality. Bodily functions are carried out optimally at a pH of 7.0 or higher, which is an alkaline pH. Studies show that a drop in pH in body tissues toward an acidic state leads to inflammation. An acidic state makes losing weight more difficult. We can help our body stay balanced by our food choices.

Skin issues that may benefit from an alkaline diet include yeast overgrowth, dandruff (seborrheic dermatitis), rosacea and other forms of skin inflammation such as psoriasis and eczema. Alkaline diets also decrease inflammation in the body and help improve chronic diseases.

Think plants! Fresh vegetables, fresh fruits, nuts, seeds, fermented soy products (miso, natto, tempeh), and other legumes, along with a lot of water are good options. Eat fruits in moderation because they are high in sugar. Berries are best! It is important to understand that alkaline promoting foods may actually be acidic —- but their effect in the body raises the pH.  Try keeping fresh lemons and limes on hand to squeeze into every glass of water that you drink – this is the quickest ticket to a more alkaline diet!

The typical Western diet is comprised of foods, which lower the pH in the body (wrong direction!). Sugar, meat, coffee, tea and sodas sugar, alcohol, white flour, dairy, and packaged & processed foods can worsen inflammatory conditions of the skin as well as the joints, muscles and internal organs, promote yeast overgrowth and may even cause a bad mood.  A more acidic pH causes minerals to leach out of our bones and speeds osteoporosis and mineral loss (which slows our cellular function). In the end, eating a diet that is mainly comprised of acidic foods can cause the body to work harder to stay balanced.

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Part II: Measuring pH of the body at home and when to incorporate acidic foods to balance the diet


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Summer Sticky Skin Remedy


Rashes and skin conditions that worsen in the heat include acne, rosacea, eczema, and fungal infections.

Prevention is key for these types of rashes as they are commonly chronic. Since we can not avoid the heat and humidity, here are our suggestions for prevention:

  • Acne- This sticky August can cause your skin to become more oily and cause breakouts, it is also important to reestablish a hydration balance to the skin. Best prevention is a cleanser for face and body to deep clean the pores followed by glycol and salicylic acid pads (available for purchase at our office, ~$25) after a sticky day or activities.
  • Rosacea- If you have redness on the cheeks, it may be rosacea. Heat is a known trigger for rosacea, and we offer many products to combat that flushing. A daily sunscreen with Zinc oxide and Titanium dioxide as the active ingredients can calm the skin and prevent facial flushing. Skin Ceuticals company has developed a product, Redness Neutralizer used twice daily and can be helpful with rosacea or just “redness”.
  • Eczema- If you have been told you have Eczema, if it important to prevent this chronic condition from flaring. Atopic Dermatitis and Contact Dermatitis are inflammatory conditions that are made worse in the summer months from a variety of factors. If you have seasonal allergies along with a rash, daily antihistamines can prevent. The best prevention is avoidance of triggers along with an emollient cream head to toe every day,  our favorites are Vanicream and Epionce Medical Barrier cream.
  • Fungal and yeast Infections- We all have yeast living on our skin. When the yeast grows out of control, a person can get a skin rash called tinea. This can be as mild as discoloration on the shoulders, athletes foot, or more severe, like jock itch. Zeasorb powder is our “go to” for prevention of jock itch and athletes foot, along with Kavi coral sulfa based bar soap. Tinea that has established itself on the skin may need a prescription anti-fungal treatment.
  • Heat Rash-  This rash is caused by accumulation of sweat beneath clogged pores on the skin. The rash will usually go away after the individual cools down, but it may persist if and need antibiotic therapy. Best first line treatment is a cool shower.
  • Bug Bites- Avoiding bug bites it difficult this time of year! We offer an all natural insect repellant here in the office, you can pick up any time. Avoiding peak insect hours is a great idea as well. If you get stung, pick up some hydrocortisone and saran anti itch cream from the drug store. If that doesn’t do the trick, come see us!

 If you would like to discuss your skin care regimen, our Nurse Practitioner Dr. Kingslea Moore can see you quickly for an evaluation and treatment.

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Safe Celebrating on our Independence Day!

Happy Fourth of July everyone!


Don’t let this be you…pocey3tns0






Sun protection is key when we are enjoying this beautiful place we call home. Sunscreen is one of the many avenues we can protect ourselves from skin cancer and aging.

#1 Mineral Based Sunscreen

Why “Mineral Based”?

Titanium dioxide and Zinc oxide have reflective characteristics due to these particles residing on the surface of the skin that ricochet UVA/UVB off of the skin rather than penetrating the skin like other non-mineral based absorptive sunscreens.

Other sunscreens on the market are chemical based sunscreens that work by absorbing the photons of light and convert them to heat. The reaction takes place on the surface of your skin and produces free radicals-this may contribute to the creation of skin cancer. This is also why chemical sunscreens feel “hot”, “burn” or sometimes sting the eyes.

Look for sunscreen with active ingredients of Zinc Oxide and Titanium Dioxide, they are the best available to fight against cancer causing beasts and for prevention against the not-so-pretty age and sun spots to strengthen – not weaken the glow of our youth.


If you’re accomplishing proper protection:

  • FACE: 1 teaspoon amt. (adult face)
  • BODY: 1oz. or shot glass size amt. (adult body)

#2 Sun Protective Clothing

Clothing and hats have as much or more sun protection than sunscreens. And the thicker the material, the more protection. For example, a white cotton t-shirt has an SPF of about 8-10. A baseball cap will protect the scalp, but is a very insignificant SPF for the face. Wide brimmed hats and SPF shirts or rash guard/shirts shirts are key. A quick test is to hold it up to light or the sun and see f you can see through the fabric, that is the amount of rays coming through to your skin.

#3 Daily Antioxidant Serum

Vitamins are critical for your body and play an important role in maintaining healthy, skin. Aging skin naturally loses Vitamins over time and exposure to UV light, pollutants and cigarette smoke.  You can fight aging by replenishing your skin’s vitamin levels to help to combat and even reverse time’s effect on your face. Two antioxidant serums that the Sheperd Integrative Dermatology team stands behind are Skin Ceuticals C E Ferulic®, and Epionce Intense Defense Serum.


Skin Ceuticals C E Ferulic® is an antioxidant combination that delivers advanced environmental protection against photoaging by neutralizing free radicals that cause accelerated signs of aging. It provides advanced environmental protection against damaging free radicals induced by UVA, UVB, and infrared radiation A (while protecting your collagen!). Also,increases firmness and replenishes lipids to visibly reduce wrinkles. Once absorbed, this serum can’t be washed or rubbed off. It remains effective for a minimum of 72 hours, making it an excellent addition to sunscreen


Epionce Intense Defense Serum is a complete multivitamin for your skin. This highly advanced anti-aging serum stimulates skin rejuvenation to help reverse fine lines, wrinkles, roughness and uneven skin tone while improving firmness, elasticity and texture.

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