Transformation Tuesday: A journey to clear completion

Kingslea Moore, DNP, FNP-C

I was drawn to the dermatology profession for many reasons, but the number one reason was having difficult skin and a close relationship with dermatologists growing up. Not to divulge too much information, but I struggled through many quirky skin conditions; including severe cystic scaring acne requiring accutane, eczema, warts, rosacea and a strange rash requiring biopsy, WHEW. My dermatologist was near and dear to my heart, and I knew I wanted to help people in the same way she helped me. During my undergrad, masters, and doctoral programs, I was encouraged to focus on family medicine with a broad base, and after a residency in family medicine I was still hopeful to land a job in Dermatology. Meeting Dr. Sheperd and joining her team is my equivalent to winning the lottery! Now I am able to compassionately and empathetically aid people with any level of skin care. So here it is, my no makeup selfie taken just after my first anniversary with Sheperd Integrative Dermatology.

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Needless to say it has been a long journey, and I have never been happier in my skin. Now, I want to share a few “game changers” for your skin! #nomakeupselfie is obtainable for everyone.

#1. Diet: Refer to Amy Murphy, PA’s anti- inflammatory alkaline diet. Two personal triggers are dairy and gluten. Dairy is huge in flaring acne and rosacea, and gluten irritates eczema and allergies

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 and may even cause a bad mood. Increase

Think plants! Fresh vegetables, fresh fruits, nuts, seeds… 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!

EltaMD Physical Clear

EltaMD Physical Clear

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Elta MD Physical Tinted

#2. Sunscreen: Every. Day. You get a certain amount of sun for free, and most of us have reached that amount. If you are noticing irregular pigmentation (brown spots and broken capillaries) or fine lines, that is a direct result from too much sun. Choose a sunscreen with zinc oxide or titanium dioxide, that is a physical protection that is much different than traditional SPF. My favorite is the Elta MD physical, tinted or clear, per personal preference.  Minerals, like zinc oxide and titanium dioxide are anti-inflammatory and calming to rosacea and acne. Our La Bella Donna powder is comprised of minerals that calm acne, rosacea, and protect from sun’s harmful rays (SPF 20).

If you are already in the great habit of a daily sunscreen, then the next step is a daily antioxidant serum. An antioxidant combination delivers environmental protection against aging 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!). 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

SkinCeuticals

Daily Antioxidant Serum

 

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Neocutis Lumiere Eye GAME CHANGER

#3. Hydration: Hydrate your inner health by drinking half your body weight in ounces daily, which is about 2-3 liters a day. Soak up a great renewal moisturizer at night, which is based on skin type. You can not go wrong with hydration packed Neocutis Lumiere bio-restorative eye- cream, with much needed growth factors. This gamechanger reduces the appearance of puffiness, under eye darkness, and skin aging.

 

#4. Rest and Exercise: Goes without saying!namaste

Sleeping eight CONSECTIVE hours nightly will not only make your skin look and feel better, but will increase your free radical fighters and overall positivity. 30 minutes of walking daily activates your immune system and calms the mind.

 

#5. Retinols: There is not one size fits all for retinols!

Retinols will increase skin cell SCretinolturnover, which encourages healthy skin growth while creating a more youthful appearance and keeping pore size small. It will also take care of those pesky blackheads. We will find one that is correct for your skin type with NO peeling.

 

 

#6. Laser Treatments: GAME CHANGER!

IPL Photofacial is key for pink tones of rosacea, broken capillaries, and dark spots from sun exposure growing up here in Charleston and going out on the water.

Resurfacing laser for acne scarring, the picture says it all!

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I challenge you to take a #nomakeupselfie! In a perfect world, Kingslea’s Game Changer list is the ideal timeline for your journey to perfect skin. We will customize for you and work within your budget.

 

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What are Bio-identical Hormones?

When we consider the benefits of bio-identical hormone replacement therapy, we are talking about restorative medicine and health optimization. We are getting to the root causes of illnesses, rather than just addressing the symptoms. We know that genetics play a roll in our health, but we also are aware that our lifestyle and nutrition have an effect too. What we eat, drink, smoke, and think can change the expression of our genes. Our hormone levels change as we get older and as our body changes. We have receptors on every cell in our body for hormones, and these receptors are very specific. Hormones can turn off degeneration and disease.

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Bio-identical hormones can repair, rejuvenate, protect and prevent our health issues by working as a lock-and-key mechanism with our body, turning on youthful restorative effects. By drawing blood to test health parameters and hormone levels, we can determine which levels are not in the optimal ranges. From here, we can boost them up to where they need to be. A person may see results within four months or less. The key players of bio-identical hormones are thyroid, melatonin, DHEA, and others. The sex hormones include progesterone, estrogen, and testosterone. Long-term, one can improve how he or she feels, protect brain from memory loss, depression and Alzheimer’s, protect bones from osteoporosis and hip fracture, protect heart from angina and heart disease, and protect immune system from cancer and infection. This is a more natural approach to health than pharmacological treatments conventionally offered for the aging process. The side effects are positive rather than negative.
By age 50, we are at approximately 50% of hormone function for estrogen, progesterone, testosterone, thyroid, DHEA, melatonin and growth hormone. Restorative medicine is a new approach, which can reverse root causes of decline and disease and which offer a whole body approach to wellness.

Premenopausal women have fewer incidences of strokes and cancer than men and post-menopausal women. Estrogen and progesterone have protective qualities against stroke, heart disease, cancer, and clotting. Furthermore, women receiving hormone replacement immediately after menopause have these benefits as well as reduced bone fractures and Alzheimer’s. They also have improvement in mood, skin, energy, sleep and sexual function.
Hormones work in concert with nutrition for full vitality. Hormone replacement should be accompanied by the nutrients that activate the hormone receptor and removal of toxins that may interfere with their activity. We can also look at micronutrients and antioxidants through specialized blood testing (Spectracell). Hormones and nutrition are inseparable to what we see on the skin and hair.
The process of optimizing health is multi-faceted; it is not often the case that correcting one hormone will make the difference in overall health. Sometimes lab values may be “normal,” but not “optimal.” Hormone function is more important than a hormone level. In the process of bio-identical hormone replacement therapy, we aim for optimal levels. Restoration of protective hormone levels helps prevent against cancer.
Hormonal and restorative medicine requires testing and consultation time that generally falls beyond the scope of usual insurance coverage. (These therapies are preventative medicine; insurers are geared toward the treatment of disease rather than preventing disease.) However, the medical literature and personal experience have convinced me: the benefits of nutrition and hormone optimization are profound and life altering.

Posted in bioidentical hormones, cancer, Cortisol, DHEA, hair loss, health optimization, hormones, Human Growth Hormone, Melatonin, testosterone, Thyroid Hormone | Comments Off

The Truth About Androgens and Acne

Amy Murphy, PA-C, DSDPA
I see many patients with acne in any given day at the office. Acne is caused by oil production of the skin, bacteria, clogged pores (from overproduction of keratin in the follicles), and inflammation. Sometimes when hormones are off, the skin is more oily and this leads to a break-out. Androgens, a type of hormone, play an important role in causing acne. Often, we will see female patients of child-bearing age with this condition. When checking for further causes of hard to treat zits, we may check for thyroid issues. Stress can additionally affect hormone levels, which can cause more oil production.

So what is an androgen? Androgens are a group of hormones including testosterone and DHEA-S. These hormones cause oil to be produced by the glands in the skin. As the oil increases, the pores become clogged. This process can cause black heads or comedones, the bumps common in acne. The extra oil allows bacteria to grow, creating the redness, swelling and pus-like fluid involved in acne. As oil increases in puberty, so do hormonal levels.

Hormonal acne is often found in those who notice break-outs worsening after their teenage years. Sometimes when common acne treatments fail to work, we consider hormones as playing a part in skin problems.

Another strong sign of hormonal involvement is when acne becomes worse the week before your period. Sometimes hormone levels including free testosterone and DHEA-S will be at the high, but total testosterone and DHEA-S will remain normal.

We might think of acne as hormonal in women if they notice facial hair, irregular periods, changes in voice, increased sex drive, insulin resistance, or hair loss. Inflammatory acne on the lower face and neck is another clue of hormonal factors. A specific type of hormone condition that can involve acne is PCOS (polycystic ovarian syndrome). This disorder can involve acne, cystic ovaries, irregular periods and being overweight.

Usual forms of treating persistent inflammatory acne include antibiotics and isotretinoin. If these types of acne treatments do not improve skin, other medicines such as spironolactone can be helpful in treating hormonal acne. This is an antiandrogen medication. It works by stopping androgens from working in the body before they cause clogged pores. Spironolactone can also stop testosterone from becoming active, which can help decrease break-outs. In the end, this medicine can decrease oil production by about 30 to 50 percent. It is not for women who are pregnant or trying to become pregnant. It takes three to six months to tell if it is working well.

Oral birth control pills are also commonly prescribed to treat hormonal acne. Oral contraceptives that have estrogen and progestin may reduce androgens. If someone is already taking oral birth control pills, hormonal issues can be masked. This is in part because estrogens can decrease acne.

Men can also experience hormonal imbalances. Symptoms for men may include patterned baldness and acne, among other signs.

Lytic Sport Tx
We offer several products that target hormonal acne specifically. Epionce, a botanical skin care line, offers Lytic Plus Tx. This product works to help clear pores and improve skin texture. Lytic Plus Tx is a treatment product that helps reduce symptoms and inflammatory factors of acne, among other skin issues. Patients enjoy implementing this into their daily regimen morning and night after washing their face. It also helps reduce redness, irritation, and oil production. Some of the key ingredients include salicylic acid 2.95%, azelaic acid and willow bark extract, among others.

DIM pure

DIM (diindolylmethane) supplement is a natural, organic compound that promotes healthy estrogen metabolism in men and women. It is a phytonutrient and antioxidant found naturally in small amounts in cruciferous vegetables such as broccoli, cauliflower, cabbage and Brussels sprouts. This supplement helps the body break down estrogen into helpful substances and encourage healthy levels of hormones.

Lastly, when considering diet, it is important to eat dairy in moderation when you are trying to improve your complexion. Also, studies have shown that sugars such as those in high glycemic foods including bananas, melons, and other simple carbohydrates, can worsen acne. Therefore, watching your sugar intake can be worthwhile if combating break-outs.

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Collagen Regeneration at Home? Not too good to be true

Kingslea Moore, DNP, FNP-C

      Collagen loss is natural over time with the skin the aging process caused by chronological and environmental aging, neither of which we can control. Environmental factors that decrease collagen are heat damage, free radical damage, and visible light spectrum. These factors contribute to visible signs of aging, including a loss of skin’s radiance and firmness, as well as wrinkles, laxity, and pigmentation. Tools that prevent and correct the appearance of aging skin include sunscreen, antioxidant serums, diet, fillers, and laser procedures to stimulate collagen. Food choices that have a positive and nourishing effect on collagen include omega 3 fatty acids, plant proteins, calcium, vitamin C,  and vitamin D! It is also important to avoid collagen killers, such as smoking, sun exposure, spikes in blood sugar, poor nutrition, stress, and inadequate hydration.

      A fun new addition to our product voices for anti-aging is laser procedures. In previous blogs we have discussed collagen building benefits of laser resurfacing, which are huge! If you have made the investment in your skin for a laser procedure, an at home collagen stimulating laser may be the next step in order to protect from further damage. Or if you’re not ready for a laser procedure in the office, then an at home laser may be just the thing for you! SkinCeuticals introduced their TRIA at home laser system. The system incorporates active ingredients that reduce the appearance of hyperpigmentation, and stimulate the skin’s production of collagen.

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 Daily clinical regimen to promote advanced skin correction including the only at-home laser FDA-cleared for use on the entire face and clinically proven to treat multiple signs of aging. Proven at home laser results combined with synergistic post-laser antioxidants. Laser light generates new collagen for a smoother, more youthful complexion. Tria age defying laser also enhances penetration of topical antioxidants

Step One

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Skinceuticals Tria Age-Defying Laser + Antioxidant System is FDA Cleared non- ablative fractional laser device. It is used to treat signs of aging and has been clinically proven to be effective and safe. This product will help smooth out fine lines and wrinkles.

95% of users saw an improvement in overall appearance
94% of users showed significant improvement in the smoothness of their skin
82%  of users demonstrated significant improvement in wrinkles around their eyes

 

 

 

Step TwoSkinCeuticals

Ce Ferulic 1 oz – High Potency Antioxidant, special blend of 15% Vitamin C, 1% Viamin E and .5% Ferulic Acid. Protects against environment and has anti- aging correction.

Step Three

Resveratrol BE 1 oz – Boosts skin’s own antioxidant defenses. Will increase skin’s density and help skin glow.

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Tips and Tricks to Combating Itchy, Dry Skin

hands with waterThe colder, dryer months of the year can leave us itchy and dry at times, and even bring out a skin issue that was already present. There are so many different causes of rashes, and some of these causes may be the least expected.
Soap is a frequent cause of irritating skin on the hands. The distribution of a rash will give us clues as to its culprit. When suspecting soap as the cause of hand irritation, we will check the backs of the hands and web spaces of the fingers for involvement. If just one’s palms are affected, we will look for different answers than soap as the cause.

Other questions we often ask patients when they have rashes on their hands include considering their work environment. Such questions might be asked as: do you wear gloves at work? Are you washing your hands before you put the pair of gloves on? How frequently are you changing the glove? Working with odd chemicals at work can leave us further suspicious that the work environment is playing a role in the rash.

A trick that we like to share with our patients is considering using an alcohol-free hand sanitizer. If one already has irritant hand dermatitis, applying an alcohol-based hand sanitizer is comparable to putting salt on a wound. For cracked, dry hands, Gold Bond Hand Sanitizer is a great alcohol-free option. When avoiding soap to heal irritated hands, replace hand washing with hand sanitizer when possible.

Using a hand sanitizer five times for every one hand wash should definitely show improvement in dry, inflamed hands. We recommend EO Hand Sanitizer found at health food stores to our patients for a great everyday option.

Go for soaps that are gentler when washing hands. Choose Cetaphil bar, Aveeno, Neutrogena bar, among others. In the end, decreasing frequency of hand washing along with avoiding dish soap for hand washing will be helpful. Dish soap is designed to clean chemicals and is therefore too harsh for routine hand washing. Further treatments of irritated hands include soaking them for twenty minutes, applying ointments, and wearing cotton gloves overnight. Wal-Mart, Lowes and Home Depot sell brown jersey gloves that can be used for this purpose. We carry Vanicream at our office as a healing moisturizer for especially dry skin. A great hand cream is CeraVe Therapeutic Hand Cream. If these measures do not do the trick, there is further medical management we can offer.

What if just the fingertips of the hands are affected? Frequently, this distribution of hand irritation is found on the dominant hand and affects the middle finger, index finger and thumb. Such dermatitis can be related to writing. This rash would not itch. In those that handle packages every day, this may be the cause of such a rash. Golf gloves are another common cause of this type of hand irritation.

If one has frequently sweaty hands, this can be another factor to consider with hand irritation. This cause may present as blisters that come and go with itching. If blisters on the hands are always present, it might be time to check for allergies including nickel allergy. Other times, we may see bacteria or fungus contributing to rashes on the hands.

Moving on to the eyelids, there are innumerable causes of eyelid irritation. Some causes include an allergic reaction, a product irritating the skin specifically, psoriasis, dandruff, and eczema, among others. If a rash spreads outside of the eyelids, we may check your shampoos and face soap as causes of an allergic response. If the rash is only on one eyelid, we may check if there is something on your hands that is coming in contact with your eyelids that is causing the irritation. Since nail products can often cause skin issues, consider Revlon Nail Enamels as a safe alternative to irritating nail polish.

Otherwise, mascara is one of the most likely causes of eyelid rashes. Mascara, along with other volatile solvents can be problematic in this area. We offer several therapeutic measures when seeing patients with eyelid dermatitis. Important measures to be done at home include stopping the irritants and washing your face with a gentle cleanser (such as Cetaphil or CeraVe) after shampooing. Sarna Sensitive is a calming lotion sold over the counter. CeraVe or EpiCeram cream are other calming options to apply to irritated skin on the eyelids. Remember to wash eyelids very well after washing the face when suffering from irritation.

Another common location for irritated skin can be under a ring on a finger. Women’s rings have concavities that can allow water and soap to get trapped beneath. Furthermore if wearing two rings together, this provides more space for trapped irritants. Jewelers can adjust rings to close off the concavities beneath them and offer soldering to bring multiple rings together as one.

Rashes on the face have their own patterns to pay attention to for clues of causes. If a rash of the face is in the central face only, we may worry about what moisturizers and makeup a patient is using. Even jewelry can play a role in rashes on the face. Titanium dioxide, found in mineral-based sunscreens, can release gold in jewelry, a common allergen that can be underestimated.

However, if the rash is located on the sides of the face, think about your rinse off pattern when washing. Perhaps soap or shampoo is the cause in this scenario. A good shampoo to try when needing to stop irritation is California Baby Supersensitive Shampoo and Body Wash. Free and Clear is another brand we often have patients switch to with allergic prone skin.

In regards to a rash on the neck, consider perfume as a possible culprit. Sometimes discontinuing use of all perfumes until a rash on the neck clears is a good first step. Rashes on the sides on the neck can once again point back to the rinse off pattern of shampoo.

A toothpaste allergy is a potential cause when irritation shows up on the lower lip or chin. Tom’s Toothpaste at whole foods stores is a good allergen-free alternative.

When considering any rash, remember that there are a lot of chemicals in modern day life. Even if it is a product that you have used for years, it can still be the cause of your current rash. Unfortunately cumulative exposure can lead to cumulative toxicity at times. There is always patch testing for allergies if other treatments of a rash are not working.

Amy Murphy, PA-C

Reference: The SDPA Conference in San Diego, CA 2014 with Matthew Zirwas, MD 

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