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    Finding the Right Dermal Filler

    Last updated 4 months ago

    As you age, your skin changes in many ways. Over time, the face loses volume and looser skin forms wrinkles, folds, and furrows. Dermal fillers offer an, effective, non-invasive, and long-lasting cosmetic solution to restore the youthful look of your skin by replacing lost volume and eliminating wrinkles.

    Restylane and Juvederm
    Restylane and Juvederm contain hyaluronic acid, which is a natural component of the skin. Restylane and Juvederm are generally used to improve folds and wrinkles found in the lower face. Treatable areas include the skin around the nose and lips, as well as under the eyes. These dermal fillers can also be added to the lips to increase their volume. Over time, the hyaluronic acid in these fillers is naturally broken down by the body and must be replaced. Juvederm and Restylane results typically last six to twelve months before retreatment is required.

    Perlane
    Perlane is manufactured by the same company that produces Restylane. It is also a hyaluronic acid filler, but contains larger particles than Restylane or Juvederm. Perlane treatment is reserved for more severe wrinkles and folds in the lower face around the nose and mouth. It is not recommended for lip enhancement.

    Radiesse and Sculptra
    Radiesse and Sculptra are excellent choices to add volume to the cheeks and the areas beneath the eyes. These dermal fillers prompt your body to make its own collagen for natural and long-lasting results. Radiesse is a gel that contains suspended calcium hydroxylapatite microspheres, while Sculptra contains poly-L-lactic acid. The results of Radiesse treatment are visible immediately and typically last one year or more. It may take a few months before the results of your Sculptra treatment are fully apparent, but retreatment will not be needed for two years or more.

    Would you like to learn more about dermal fillers and how they can improve the look of your face? Call Advanced Dermatology & Cosmetic Surgery at (866) 608-9531 to schedule a personalized consultation with a cosmetic dermatologist. We can help you make the right choice to achieve more youthful and vibrant skin! 

    Hidradenitis Suppurativa

    Last updated 4 months ago

    By

    James A Solomon, MD PhD 

    Director Ameriderm Research, the Research Division of ADCS

    Hidradenitis Suppurative (HS)  is a rare skin disease  which is associated with cystic painful  inflamed pustules and boils which can coalesce into tracks of scars and  pus.    Between 1 to 4% of the populations gets HS.   The disease is more common in women than men.   Although HS can develop anytime between puberty and middle age, the average age at which is starts is 21.   The chance of developing HS decreases after age 55.      It is more likely to occur in overweight individuals and smokers.  The disease severity also increases with increasing weight.      

    Up to 40 % of patients with HS come from families with HS.   Some forms are genetic and follow an autosomal dominant pattern.     The exact chromosomes or mutations involved are as yet unclear.  

    Typically it affects skin folds where oil glands are present such as arm pits, areas under breasts, around the areola of the breasts, in the groin, and between the buttocks.    Although the primary lesions are sterile, despite the pus,  they frequently become secondary infected with Staphylococcus Aureus,  Streptococcus  or other bacteria.    Nonetheless, in part due to the scarring, the infections respond poorly to antibiotics.  In addition, the bacteria frequently change which antibiotics will be effective.    Movement over the areas involved typically is painful and patients frequently must remain on constant doses of pain medication.   In addition, these areas become very malodorous.    Interestingly,  the disease also resembles a form of cutaneous tuberculosis called scrofuloderma.      With the increasing prevalence of TB, one may want to consider this rare possibility in patients who fail to respond to treatments.   In addition,  the lesions may  mimic or appear similar to deep skin infections with other micro-organisms.   These too, should be considered when the patient fails to respond to treatment. 

    The inflammation involved typically involves a mixture of inflammatory cells.    Various immunological pathways are active including  TNF-α ,  and IL-1 and other IL  pathways.    Attempts to block these pathways have and are being attempted as a manner to control the disease.        

    These lesions in part resemble severe cystic acne and treatments have been attempted using medications which help severe acne.   These treatments  may offer some relief, especially in milder cases.   Weight loss, tobacco cessation   can be helpful but not necessarily curative.   Failure to lose weight and quit smoking can contribute to disease resistance to treatment.   Unfortunately, at this time   there is no effective treatment for this disease,  although new treatments are in the pipeline. 

    CAS-CQIA is  approach  which takes into account the individual nature of the disease process.   It groups people who have similar positive or negative responses to  multiple  factors in their lifestyles and  treatments.   CAS-CQIA uses  a process which gathers information from patients who have the disease to identify  groups among them who respond positively or negatively to certain behaviors, diets, and treatments.    This information is then relayed back to the patients so they can make changes accordingly.

    Surprising Items That Can Leave Dirt on Your Face

    Last updated 4 months ago

    You may be surprised to learn how many sources of dirt the skin of your face encounters every day. Dirt, dust, and oil can cause irritation of the skin, acne breakouts, and even thickening of the skin or premature aging. Talk to your dermatologist if you have questions or concerns about the right products and daily care routine for your skin.

    Your Hands
    The average person touches their face up to four times every hour. Your hands pick up dirt, allergens, viruses, and bacteria from every object you touch. All of these irritants are then transferred to your skin when you touch your face. Your fingers may also contain oil or perspiration that rub off on the skin of your face with each touch. All of these factors can lead to clogged pores and an increased risk of acne breakouts.

    Your Cell Phone
    Cell phones serve as intermediaries between the hands and the face, transferring dirt from the fingers to the cheeks during use. Your cell phone also accumulates oils from your skin when you hold it against your face. If you don’t clean off the surface of your phone after each use, dirt and dust are attracted to this oil and collect on the surface, waiting to contact your skin the next time you make a call.

    Your Towel
    Washing your face is an essential part of any skin care routine to remove accumulated dirt, oil, and perspiration. However, you may be nullifying all of your face-washing work if you are using a dirty towel to dry your skin after cleansing. Dry you towel completely between uses and switch to a fresh towel every few days to prevent the accumulation of dirt and bacteria.

    Advanced Dermatology & Cosmetic Surgery offers a variety of cosmetic dermatology services including chemical peels, laser skin rejuvenation, and facials. You can reach us by calling (866) 608-9531 to book an appointment with a board certified dermatologist at any one of our 50 locations. Visit our website to check out our current special offers

    Basal Cell Carcinoma - Not as insignificant as you may think (Part II)

    Last updated 4 months ago

    Basal Cell Carcinoma

    Not as insignificant as you may think

    (Part II)

    By

    James A Solomon, MD PhD 

    Director Ameriderm Research, the Research Division of ADCS

    Basal Cell Carcinoma (BCC)  is the most common cancer for  adults in the US and Western Europe.   About 1/3 of these people will develop a BCC during their lifetime.   This may also be expressed as about 1 to 1.5  people /1000 population/ year.   This rate is about double that seen in the 1980s.   Typically they are small pearly nodules with a central ulcer; about 1/3 appear on the head and neck.  They grow slowly. For the most part BCCs are easy to treat and cure.     They may be removed surgically by a simple excision or Moh’s microscopically controlled surgery, electrodessication and curettage (burning/ scraping), or laser. 

    Although most BCC can be successfully treated there exists a group of  aggressive or advanced BCC (aBCC) in about 0.1% of the population.   Although 0.1 % sounds like a small number with the population of the US  at   ~ 317,000,000,  0.1%  would then be ~ 317,000 individuals.   Recently,  a prescription oral  medication has become available to  helps treat these aggressive BCCs.     

    Furthermore,  there are patients who present with multiple BCCs simultaneously.   About 25% of individuals who get one BCC will get a second one.  These individuals then are at even high risk to get a third, and so forth.   Soon the risk of getting another BCC in these people is greater than the risk of any getting their first BCC.   In addition, the timing between each subsequent BCC is typically less than the previous period until these patients start developing multiple lesions almost simultaneously.   They may have 6, 12 or even dozens of simultaneous lesions.     Typically all of the  BCC’s cannot be  removed at a given surgical session.   Thus, the surgeons may not be able to excise the lesions as quickly as they are coming.      

    Furthermore, there is a genetic disorder referred to as Basal Cell Nevus Syndrome ( BCNS) wherein these people develop several simultaneous BCCs as early as theirs teens and multiple by their early adult years.  They frequently spend much of their time have these tumors removed.     In addition to BCCs these individuals may present with tiny pits in their palms and soles, calcification of the falx cerebri, fused or bifid ribs,  coarse face, cleft lip, fused digits, abnormally shaped sternum, ovarian fibroma and neurological/brain tumors called medulloblastoma.    At this point, the only treatment available is for those BCNS patients with aBCC being the oral medication noted above. 

    CAS_CQIA By James A Solomon, MD PhD

    Last updated 4 months ago

    CAS_CQIA

     Complex Adaptive Systems approach

    to

    Continuous Quality Improvement Assessments

    By

    James A Solomon, MD PhD

    Director Ameriderm Research

    CAS_CQIA (Complex Adaptive Systems approach to Continuous Quality Improvement Assessments) If your disease seems to come and go without clear cut reasons and you seem to respond or not to respond to treatments without clear cut reasons, but you believe your problem is not unique and that others -somewhere out there - may have similar responses. Moreover, you may think that if you worked together with these people you could help each other avoid the pitfalls and pursue what works. Modern medicine has failed until recently to take on this approach to identify groups of individuals whose diseases respond similarly to their interactions with the world at large. Recently, CAS_CQIA has been the focus of a new approach in modern medicine to chronic diseases which utilizes high tech computer statistical array analyses of large groups of individuals to identify people who react in similar ways and use this knowledge to benefit these individuals.

    In order to develop these assessments knowing what people believe helps and hurts in association with other events is key. For example, a given treatment works unless there is significant stress at work but not at home, it is Spring not summer and the weather is unusually cold, tomato based foods were eaten 2 days earlier for lunch but not one day earlier for dinner, the multivitamins contained no minerals, and one drank only decaf-coffee - however if one drank decaf tea everything was fine. Try to explain this during a 15 minute visit to the doctor. Even if the doctor listened and heard what you said, there has been no formal system to enter this information to see if there was anyone else out there with the same reactions or even opposite reactions. Now there is so fire away.

    Vegan diets play an interesting role for which there is some scientific basis. Patients report relief from vegan diets. Some studies suggest that the basis of improvement is through immunosuppression secondary to malnutrition from vegan diets. There may be a better explanation. Calf, not human, is the reagent used to test for ANA (anti-nuclear antibodies) which is used to confirm the presence of antihuman antibody. Be that as it may, it also shows the patients make antibody to beef nucleic acids. In addition, rabbit is the reagent for several other auto-antibodies to nucleic acids. Although there is minimal data showing calf dna in circulation in humans, studies with rabbits shows individuals who eat rabbit in conjunction with a low fibre diet may have segments of rabbit DNA in circulation. Thus, in theory SLE patients who do react to rabbit reagent targets may have circulating antibodies against rabbit DNA which will react in this scenario. One can extrapolate to a similar scenario with beef DNA. Thus, avoiding ingesting these may help
     

    This becomes a bit complicated through those who eat a high fibre diets may not have circulating DNA and thus not improve, those whose Vegan diet is poorly nutritional may improve due to the inability to develop an adequate immune response or worsen due to catabolism (eating oneself) to replace the loss of food thus releasing DNA. Furthermore, the term non-dairy just means lack of milk fat. Only the term 'parve' means lack of any milk products. There is little published concerning the assessment of the nutritional status of people following various Vegan diets. Thus, to unravel this issue will take a significant imput from patients who follow the diet to elucidate these issues and see which do and which do not contribute to improvement over ? periods of time.

    Are there scenarios which seem to help or seem to hurt. If a form is developed using CAS_CQIA to assess patients with psoriasis, alopecia areata,  or lupus  what questions or issues to be addressed would you want to be included in the process?  Are there scenarios which seem to help or seem to hurt. If a form is developed using CAS_CQIA what questions or issues to be addressed would you want to be included in the processAre there scenarios which seem to help or seem to hurt. If a form is developed using CAS_CQIA what questions or issues to be addressed would you want to be included in the processAre there scenarios which seem to help or seem to hurt. If a form is developed using CAS_CQIA what questions or issues to be addressed would you want to be included in the processAre there scenarios which seem to help or seem to hurt. If a form is developed using CAS_CQIA what questions or issues to be addressed would you want to be included in the process Are there scenarios which seem to help or seem to hurt. If a form is developed using CAS_CQIA what questions or issues to be addressed would you want to be included in the process

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