Lifestyle post: French babies, whole foods, and productivity.

Note: Dermatology-free post!  Ever since I downloaded Amazon’s Audible, an audiobook app for your iPhone and other devices, I have been a “reading” machine!  It probably helps that my clinical load is much less for the last month, freeing up space for some other things.

One of my majors in college was anthropology, so I really love anything that analyzes why we live the way we do.  In the last month, I have “listened” to the following three books that have shaped my worldview more than I expected: Pamela Druckerman’s Bringing Up Bebé (for the second time), Michael Pollan’s In Defense of Food, and Chris Bailey’s The Productivity Project.  I have to give credit to both my husband Brian Dosal, and my brother-in-law Eric Dosal for the recommendations for the last two books.

Here is a quick summary of what I have learned:

French babies are well-behaved, American babies aren’t.  Much of it comes from a newly emerging style of parenting (probably only within the last 20 years, our parents weren’t like this), best understood as “helicopter parenting.”  It’s a world where everything revolves around the baby and the kids, mothers schlepp and chauffeur their kids to four after school activities and then cook 3 different meals for each kid, and reward kids for every mediocre achievement.  It’s why we have difficulty with the “cry it out” method. French mothers don’t run to their babies (non-serious) cries, they walk.  They expect their children to learn how to sleep through the night at a very young age, and to be adventurous eaters.  They don’t hover over their children on the playground, they give their kids some space to fall and pick themselves up (safely of course).  The book is written very well by an ex-pat American journalist raising her two children in France, and is thus able to compare the two parenting styles.  She is very witty and the books reads very fast.  It makes you think twice about how we interact with our little people.

In Defense of Food – the evolution of the modern American diet is anything but natural.  Most of what we eat today is derived from one of four food crops: corn, soy, wheat or sugar.  The reason for this has to do with the efficiency and practicality of processing wheat and corn, allowing it to feed more individuals and to keep longer without perishing, but not without a major nutritional price.  The dietary evolution is also greatly derived from American farming politics, with the Nixon-era administration largely subsidizing these crops, forever instilling them in our diet.  Pollan’s tagline is catchy – Eat food, not too much, and mostly plants.  The nutritional reasons for this are enormous, and whatever your diet du jour – Paleo (which I used to love), South Beach, Mediterranean, low-sugar… the most important emphasis should always be on fresh whole foods, and minimally processed foods.  I think one of the most convincing arguments for embracing Pollan’s philosophy is that wherever the Western diet is introduced, Western diseases (cardiovascular disease, diabetes, obesity, hypertension) soon follow.  A native culture that adopts a Western diet and lifestyle is almost guaranteed to see these diseases, that were largely not found originally, surge in frequency.  I have never been so motivated to escape from the modern way of eating and switch to spending MORE time cooking, MORE time eating, and MORE time cleaning, as all of these are usually indications of a meal prepared with intention and fresh ingredients, and not something processed and ready-prepared for me.  It also allows the enjoyment of a meal, and the cultural connection with whom you are eating.  My favorite quote from the book was: “Think of the meal as an aesthetic experience,” and not just as a means to the end of nutrition.

The Productivity Project – this book was different for me.  I originally felt like I was wasting valuable time and productivity by listening to “The Productivity Project!”  While it did tell me some things I already knew, it also really opened my eyes to why I don’t follow my own advice.  It helped me try to break away from the bad habits that prevent me from doing my best work in the very limited time between work, sleep, baby care, and eating.  What I really liked was that the book was very apropos to the new digital era, especially as we become more and more reliant on our smart devices.  It is a different world than it was just five years ago.  Here are some of the things that I learned:

  • We are digitally wired to crave attention from our phones.  Each time we get a new buzz or notification of a message, we get a hit of dopamine that makes it feel like an addictive drug.  We have become conditioned to expect this throughout the day.
  • Our brain is not evolutionarily equipped to deal with constant interruptions.  Each interruption, whether a text message, email, or checking Facebook, can delay focusing on your task at hand by as much as 25 minutes!!!
  • Multi-tasking is exhilarating by nature, but it is inherently bad for us.  It actually affects our memory so that we don’t remember as much!  I have found this to be true, and actually had been worried about it.  A self-proclaimed “multi-tasking master,” I’m never NOT doing two things at once.  I had actually downloaded brain games like Lumosity and contemplated taking gingko biloba because I found that I was forgetting things more easily.  Now I know why!
  • Meditating is incredibly easy, has a bad reputation, and can dramatically affect your productivity.  All it consists of is: 5 minutes (or more) of only concentrating on your breath.  After overcoming internal resistance and negative inertia, I finally was convinced to try it.  I was bored at first, but then surprised when my timer went off.  Bailey swears by meditation as a way to become more deliberate, focused and intentioned in his day.  Whether a placebo effect or not, this has been the one thing that I tried in the book that made a major direct impact on my productivity.  The day after, I was more productive than any other day in the preceding two weeks, which includes writing this blog.
  • Disconnect as much as possible.  When working on an important task, turn off alerts or disconnect from the internet all-together.  Turn off your phone or leave it in the other room during meals or at the end of the day.  It’s good for your brain.
  • Break down aversive tasks down to a level that is no longer intimidating and so you no longer feel resistance to it.  For instance, I did not want to workout yesterday.  But I told myself I would only do it for five minutes, then I could stop.  Of course what happened?  I got over the inertia of starting the workout, and then started to enjoy it!  I ended up walking for 60 minutes when I only intended to walk 5 minutes.

These three books, while seemingly unrelated, have been eye-opening with regards to major factions of my life: child care, wellness and nutrition, and productivity.  Hopefully one of these topics resonates with you, and let me know if you enjoy the books!  My new-found audiobooks have transformed my car rides into pleasant learning trips, and have been great reasons to go out for a walk!

Dr. Jacquelyn Dosal is a board-certified dermatologist practicing in Miami, FL.

 

 

New Year, New Location

Dr. Jacquelyn Dosal, Dermatologist

Happy 2016!  2015 was a spectacular year for me both professionally and personally.

Most importantly, 2015 was marked by my first year with my daughter Caroline, who turned one in November.  It’s been such a joy to see her grow and learn – more than I ever expected!  It’s been so fulfilling to be a “mommy” in addition to being a dermatologist – it gives me more depth to my overall perspective.  It has also helped ground my approach to both patient care and family life.

IMG_5417 Brian, Jackie, & Caroline Dosal at Moving Day Miami, a walk for the National Parkinson’s Foundation.

Looking ahead, 2016 marks a new and exciting chapter for me professionally!  I am thrilled to announce I will be joining the prestigious Skin Associates of South Florida, alongside the brilliant Dr. Joely Kaufman, Dr. Jeremy Green, Dr. Christopher O’Connell and Dr. Cynthia Golomb.

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Skin Associates of South Florida…

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This is what I do… I daydream about the skin.

Recently I spent 3 days at a University of Miami Dermatology 60th Anniversary Conference learning from leaders in the field (most of which were UM alumni), my peers, and even our super smart current residents.  I’m a sucker for these meetings – I love to soak it all in.  I always learn so much from these meetings, and it’s learning that challenges me to constantly improve with the ever-changing science of medicine.  

Learning, I realize, is one of the favorite parts of my career.  I’m fortunate to be one of those people who absolutely loves what I chose for my profession. I’m also privileged to work part-time at the University of Miami, where I see challenging cases, as well as teach residents. I’m often referred cases that have seen 3+ dermatologists before seeing me, all without success.  It’s a great learning opportunity for our residents, whom I love having in my clinic. We feed off each other, challenge each other, and learn together from difficult cases.  I’m honored to be part of their education in one of the highest ranked dermatology programs in the country.

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Stacks and stacks of dermatology journals.

I have a little time off before my official start at Skin Associates of South Florida (SASF) on March 9, so those days that I’m not at the University of Miami, I’m spending quality time with my daughter. When she is asleep, I’m able read all of those dermatology journals that were stacking up in my office – the sight of which drives my neat-freak husband mad.  This “in-between-jobs” time (a phrase which is not quite accurate, I’m still at UM quite a bit) has been a refreshing chance to catch up, learn more, and have some time for self-betterment that was not possible in the hustle and bustle of a full time practice.

Having this extra time and space has also allowed my brain to get excited and wander (and wonder) into the depths of dermatology issues.  This is what I do… daydream about skin issues.  The skin is a wild puzzle piece of the body which tells a story of the body that no other organ can.  It’s complex, challenging, and it excites the heck out of me.  I’ve already come up with a few new research projects for 2016 that have me beyond excited this year!   Fortunately, both University of Miami and SASF are leaders in dermatologic research, so I’m in good company.

In medicine, there are always questions that need answers, there are always new targets for therapy, and the learning never ends… which is part of the fun! I suggest that everyone strive to make a clearing for some time to dedicate to what you love to learn about.  Whether it’s reading a book, journal article, blog (like mine!), a TED talk, an Audible book, or even just time outside. Create a space for daydreaming.

Dr. Jackie Dosal

Another Reason to Keep Your Resolutions…

Sticking to those New Years resolutions?  Need a little motivation?  Maybe I can help.  Many of the good things we do for our body and mind can have a positive effect on our skin.  What a nice bonus!  Don’t we all want glowing skin?

Let’s review below:

Move daily – Get that blood flowing and move daily!  Whether it’s a walk, a fitness class, yoga, or pilates, just move your body. Research shows that individuals over 65 who performed at least 3 hours of moderate to vigorous exercise a week were able to reverse the signs of aging. Compared to non-exercising seniors, skin biopsies from the buttocks of the exercising individuals showed features that looked more like a 30-year-old!  Exercise gets the blood flowing, brings nutrients to your cells, lowers stress, strengthens the immune system, and much more.

My husband and I recently got the FitBit fitness tracker, and it has been a great motivation to go for a walk rather than sit in front of the TV.  We challenge each other to who can walk the most steps in a day.  Depending on the day, the recommended 10,000 steps can be very easy or almost impossible to accomplish without some effort.  We have to consciously prioritize a walk or activity over TV or work.  Considering the modern lifestyle that leaves us sitting in front of the TV or computer for hours, the challenge to be more active is a welcome initiative.  The line “Sitting is the new smoking” has resonated with many folks, myself included.  Now that you know it’s also good for your skin, get moving!  

Avoid added sugar – I think most of us can agree that there is an over-abundance of sugar in the American diet.  Sugar is added to just about everything we encounter in the grocery store (which is why the advice of shopping the perimeter of the grocery store is so true).  And why wouldn’t manufacturers add sugar?  It makes everything taste better!  Sugar actually coats innumerous targets in the body, making them function subpar.  Most important to the skin, sugar also coats collagen (a process called glycation) and makes it stiffer, making our skin look sallow, aged, and stiff.  So think twice before that second helping of dessert… it may taste sweet but may be making your skin look sour!

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Glycation of collagen makes it bulky and stiff.

 

Get more sleep.  This should be on everyone’s resolution list!  Sleep is the time when the body can repair itself.  Sleep deprivation means more stress and increased cortisol levels.  Increased cortisol levels can wreak havoc on the skin and cause acne breakouts, skin rashes, and worsening eczema or psoriasis.  Make sleep a priority.  Turn off the TV earlier than usual, make yourself a cup of tea, settle down with a good book (preferably paper and not on a screen like an ipad, as the light prevents the brain from knowing sleep is near), and try to start this routine 30-60 minutes earlier than usual.  You will be surprised how refreshing it can be.

This last resolution that may not have been on your list… but it’s an easy resolution to keep — and you can start it at any time, it doesn’t need to be New Years!  WEAR SUNSCREEN EVERY DAY, 365 DAYS A YEAR! Put one of my favorite sunscreens next to your toothbrush, and put it on every morning, rain or shine.  Do I need to show you the twins?  One wore sunscreen and the other didn’t.  

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Differences in lifestyle show how UV exposure ages one twin decades in comparison to the other twin.

While the photo may look exaggerated, all of us will eventually experience some of the tarnishing effects of the sun such as brown spots, dry skin, and/or wrinkles.  I got my first brown spots after only 5 years of living in the Miami sun!  

Damaging UV rays penetrate car and building windows, so it doesn’t matter if you “never go to the beach.”  

Unless you live in a windowless basement and never leave the house, you are always encountering damaging UV rays.   Love your skin and apply a sunscreen daily… you will thank me later!

And…. you have my permission to cheat once in a while…. but only with a glass of red wine and a piece of dark chocolate… both are great for the skin! Resveratrol and antioxidants, baby!

Cheers to 2016!

Dr. Jackie Dosal is a practicing board-certified dermatologist at South Florida Skin Associates and is on clinical faculty at the University of Miami Department of Dermatology.  

New Year, New Location

Happy 2016!  2015 was a spectacular year for me both professionally and personally.

Most importantly, 2015 was marked by my first year with my daughter Caroline, who turned one in November.  It’s been such a joy to see her grow and learn – more than I ever expected!  It’s been so fulfilling to be a “mommy” in addition to being a dermatologist – it gives me more depth to my overall perspective.  It has also helped ground my approach to both patient care and family life.

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Brian, Jackie, & Caroline Dosal at Moving Day Miami, a walk for the National Parkinson’s Foundation.

Looking ahead, 2016 marks a new and exciting chapter for me professionally!  I am thrilled to announce I will be joining the prestigious Skin Associates of South Florida, alongside the brilliant Dr. Joely Kaufman, Dr. Jeremy Green, Dr. Christopher O’Connell and Dr. Cynthia Golomb.

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Skin Associates of South Florida is one of the leading dermatology centers in the country, and pioneers many of the state-of-the-art dermatology and cosmetic services for non-invasive rejuvenation. I’m very excited to be joining this talented group of physicians.  My first appointments will be available in March 2016 – mark your calendar!

“A good beginning makes a good end” – English Proverb

Cheers to 2016!!

 

Dr. Jacquelyn Dosal practices general, cosmetic, surgical, and laser dermatology in Miami, FL.

Holiday Skin Care Gift Ideas and Stocking Stuffers

Looking for some last-minute gift ideas?  I’m here to your rescue.  Here are some great holiday skin care ideas that are good for anyone.  You may recognize some of these products, as they my favorites!

Great for ANYONE:

CeraVe AMCeraVe AM Facial Moisturizing Lotion – this lightweight morning moisturizer is gentle for all skin types (including acne) and includes an SPF of 30 – excellent for daily use.  Retails about $16.

For someone looking to step up their skin care:

Elta MD UV Clear SPF 46La Roche Posay AOXLa Roche Posay Mineral SPF 50

 

Take your pic – any of these 3 products would be a nice way to boost your skin care regimen.  

Elta MD UV Clear SPF 46 – great as a daily moisturizer.  It contains niacinamide, which is great for treating redness and can be helpful in acne.  Retails about $30.  Now comes in tinted or non-tinted.

La Roche-Posay Anthelios AOX – Daily moisturizer with sunscreen and a serum feel.  Layers lightly under makeup or a heavier moisturizer.  SPF 50.  Plus it has added antioxidants, making it a multi-tasker!  Retails about $42.

La Roche-Posay Anthelios 50 Mineral – Lightweight mineral sunscreen.  One of my favorites for rosacea or melasma!  My patients love this sunscreen.  It comes tinted or non-tinted, blends in beautifully.  Retails about $35.

Luxury Gift Ideas – for someone really special!

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Alpheon Beauty Eyelash Serum – an alternative to Latisse.  This serum is non-irritating and works pretty fast!  I was amazed!  I couldn’t tolerate Latisse and this serum has made my eyelashes grow long enough touch my sunglasses!  Retails $110.

 

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Neocutis Journee Riche SPF 30 (with PSP) – This creamy but light moisturizing sunscreen contains growth factors and antioxidants for a power-packed anti-aging solution.  Use it in the morning, and a retinol at night.  Retails about $144.

 

Stocking Stuffers:

nibhp0mv_201305151237184744Avene High Protection Tinted Compact with SPF 50- reapply your SPF without messing up your makeup!  A must have for anyone with melasma – use before going out to lunch, or as a touch up when going to happy hour after work.  Retails about $26.

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For the inconvenient zitLa Roche Posay Effaclar Duo – my favorite over-the-counter spot treatment for acne.  Retails about $30-36.

 

 

 

 

719tjesiril-_sx522_Neutrogena Hydro Boost – a nice starter hyaluronic acid gel/cream.  Great to use after your evening retinol/retinoid.  It’s fairly basic, but one of the more affordable hyaluronic acid gels on the market. Retails about $20.

 

Happy Holidays!!


 

Dr. Dosal is a board-certified dermatologist practicing in Miami, FL.  She has no financial conflicts of interest to disclose.

Dr. Dosal named a RealSelf Top Doctor

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Based on her dermatology credentials, expertise, patient results and satisfaction, Dr. Jacquelyn Dosal has been selected as a “Top Doctor” on RealSelf.com.  RealSelf.com is a patient education website and online community for anyone considering a dermatologic procedure.  In order to be selected as a “Top Doctor,” the physician must be board-certified, highly rated by her patients, and active in educating patients.  Less than 10% of Real Self doctors achieve this honor.

Dr. Jacquelyn Dosal is a practicing dermatologist in Miami, FL.

How to select the best sunscreens

Summer is the time where I get alot of questions regarding sunscreens. It’s no wonder… the flood of information out there can be very confusing. I offer up a fairly comprehensive summary of what you need to know this summer to protect your skin. Here are some basics:

Considering that SPF was determined using experiments with 2 mg/cm2 of sunscreen, which is way more than anyone uses in real life (we generally use less than 1/3 of what we are supposed to), we are all getting less protection than we think. For that reason, I usually recommend an SPF of 30 or more (the sun laughs at less than SPF 30, especially here in Miami), one with the label “Broad Spectrum,” and to reapply every two hours. UVB rays cause sunburn and skin cancer, while UVA rays penetrate deeper into the skin, causing skin aging, cell damage, sun spots, and wrinkles by breaking down collagen and elastin. It is important to block both of them, and SPF only indicates the UVB protective power. “Broad Spectrum” indicates that the particular brand also blocks UVA. See this lovely infographic by Dr. Michelle Levy that illustrates how UVA and UVB damage the skin.

UVA UVB infographic

Why not use SPF 100? There is a miniscule incremental benefit in protection above SPF 50, so much that the FDA proposed banning the labeling of higher SPFs, as it can be misleading to the public. SPF 100 blocks 99% of harmful UVB rays, while properly applied SPF 50 blocks 98% of the same rays. Something about an SPF of 100 gives people a false sense of security, and they are more likely to improperly use it or expose themselves to the sun for longer. Additionally, there is some evidence that having the very high SPF makes it more difficult to chemically formulate a sunscreen with great UVA protection, which is just as (if not more) important as UVB.

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Reapply! The most common reason for sunburn is missing an area of your body and forgetting to reapply every two hours.

There are so many sunscreens on the market, how do I know which one to use?

I classify my sunscreens by the type of use: everyday useintense sun exposure (like going to the pool or beach), athletic use, and those for babies. Let’s start with babies:

Babies: Baby’s skin at less than 6 months of age hasn’t yet developed the same type of barrier protection as an adult. For that reason, the American Academy of Dermatology will generally recommend sun avoidance or sun protective clothing (look for clothes labeled with UPF- iPlay makes great ones). When sunscreen is needed, a physical sunscreen is best. Physical sunscreens bounce UV rays off the skin, as opposed to chemical sunscreens which are excellent at protecting the skin, but baby is more likely to be sensitive to these products (note: most sunscreens are chemical sunscreens). You can recognize a physical sunscreen because it only has one or two active ingredients: zinc oxide or titanium dioxide. These are some of my favorites: CeraVe BabyNeutrogena Pure and Free Baby SunscreenBlue Lizzard Baby. (I don’t like the one made by the Honest company — I find it very hard to rub in and sticky).

Beach or pool use: As mentioned earlier, a Broad-Spectrum sunscreen with an SPF of at least 30 is best. Water-resistant (now labeled as 40 or 80 minutes) is also a must. The key is to reapply every 2 hours! Pick your favorite and go with it… Sunscreen only works if you use it! Here are some of my favorites: La Roche Posay Sunscreen MilkNeutrogena Ultra SheerCoppertone Oil-Free FacesNeutrogena Beach Defense.

Everyday Use: Yes, you should be wearing sunscreen every day!!! It’s not only to protect yourself from skin cancer, but if you want to look young, the MOST important intervention is sunscreen! See the difference between these twins, one who practiced sun protective measures, and the other who didn’t. The twin that protected herself from the sun looks at least ten years younger than her twin sister. Having a tan can be nice in the short term, but your skin will pay for it. By the time most people hit age 30, their skin can start to show their prior indiscretions! Time to embrace your inner Anne Hathaway. Pale is beautiful.

The sunscreens I like for everyday use are those that feel like a moisturizer, are very light and sheen, and layer well under makeup. Sunscreen should be layered under your makeup, even if your makeup contains SPF…. it’s not enough. Here are my favorites: Elta MD UV ClearLa Roche Posay AOX SerumNeutrogena Healthy DefenseCeraVe AM.

Athletic Use: This is a tough one. Intense exercise or very hot conditions cause you to sweat like it’s raining. Even water resistant sunscreens can be tough to keep on, and forget reapplying on that wet skin. I’m still in search for a good one, and would love to hear your comments/recommendations below! I would definitely recommend UPF moisture-wicking clothing for tennis, fishing, or other activities, as these actually keep you more cool than tank tops and have consistent sustainable sun protection.

Sprays: Personally, I love the convenience of sprays. However, it seems like people are more likely to under-apply or miss certain areas of their body, potentially leading to sunburn. There are also some questions about the possibility of inhaling the aerosolized chemicals, and we don’t yet know the dangers of this. I still use sprays sparingly when I need the convenience, but the jury is still out as to their proper role.

When should I be using a non-chemical (a.k.a. physical) sunscreen?

The majority of sunscreens on the market contain excellent scientifically developed chemicals that block a combination of UVB and UVA rays. For the vast majority of people, chemical sunscreens are perfect. In some cases, a physical blocker is preferred. For instance, in babies less than six months of age, I recommend a physical blocker for reasons stated above. There are 3 other scenarios where I prefer physical sunscreens: sensitive skin, rosacea, and melasma.

I know many people who tell me they are allergic to every sunscreen that they have tried. My bet is that they have not yet tried a purely physical sunscreen, as they can be difficult to find. While regular sunscreens have a fairly high rate of allergic contact dermatitis, physical blockers have almost no reactive potential. These are my favorites for non-facial use: Neutrogena Sensitive SkinNeutrogena Pure and Free Baby SunscreenBlue Lizzard. See below for facial sunscreen recommendations.

Do you suffer from flushing, red pimple bumps, skin burning, and/or sensitivity to most products? Well then you might have rosacea, and I definitely prefer for you to wear a physical sunscreen. Rosacea and melasma (those brown patches on the face that come with sun or pregnancy) are very sensitive to heat, and chemical sunscreens produce an imperceptible amount of heat, potentially flaring the skin. In order to minimize anything that can exacerbate rosacea or melasma, I recommend a pure physical sunscreen for these heat sensitive conditions. Physical sunscreens bounce the UV rays off the skin, and are inactive on the skin. In both rosacea and melasma, sunscreen is mandatory. You will find with changing sunscreen alone, your skin may dramatically improve. These are my favorite physical sunscreens for daily facial use: La Roche Posay Anthelios Mineral SPF 50Elta MD UV Physical SPF 41SkinCeuticals UV Physical DefenseCeraVe SPF 50 Facial Sunscreen LotionAvene Mineral SPF 50. And don’t forget to reapply. For the sake of convenience, I like the following two products to help women reapply sun protection after they have applied their makeup. No one wants to put on a lotion sunscreen to a freshly painted (ahem, made-up) face. Use these products to layer on top of your pretty face throughout the day: Avene compactColorescience Sunforgettable Mineral Powder Brush.

In conclusion, don’t forget to practice other sun safe behaviors, such as wearing polarized sunglasses, protective clothing such as hats, UPF clothing, UPF scarves (see these great ones by Blox Sun), and seeking shade during peak hours of UV intensity, 10 am to — 4 pm.

I’d love to hear your thoughts and invite you to comment below!

Stay tuned for my take on the topic of Vitamin D and the Environmental Working Group’s rankings of sunscreens.

Photo credit: Shutterstock

Dr. Jacquelyn Dosal is a board-certified dermatologist practicing in Miami, FL.  About Dr. Dosal: http://goo.gl/hbgqZW

Grateful – A Young Woman’s Journey for Health

I’m feeling quite grateful today in many ways. I just had lunch with an old friend from my medical training. She’s always been a lovely person, but today, I was reminded how truly beautiful she is inside and out.

Nancy, at 32, is a two-time breast cancer survivor in addition to having lost her mother at a young age due to breast cancer. She recently underwent a total mastectomy with reconstruction, and the aftermath left it difficult for her to exercise due to removal of muscles in her back used for her reconstruction. In turn, she gained about 25 pounds after her surgery. The pain of losing her mother to cancer, then getting diagnosed herself, along with a recurrence and painful surgery are enough for anyone to give up. But not Nancy, she always keeps a smile on her face and tries to look at the bright side — her attitude is inspirational.

Today at lunch, we talked for a while. She was disappointed at her weight but motivated to lose the pounds. She splurged on a personal trainer and reported it has been “life-changing” for her since it’s helped her get out some energy and internal frustration.

While her physical recovery has been taxing, there were two other aspects of her journey that I couldn’t help but appreciate: (1) her struggle to accept her surgical scars, and (2) her lifelong battle with acne. Both may be easily overlooked or tossed aside as unimportant, but with the skin being my passion, I knew that it was more important to her than she let on.

Nancy told me that she has finally started actively dating, but hadn’t found the right person yet. Part of her hesitation to be more pro-active about her dating life originates from self-consciousness about her surgical scars. While easy to feel comforted about your appearance when in a relationship with a loving partner, it is harder to flaunt surgical scars when developing a new relationship.

I never truly appreciated how difficult the breast cancer journey can be for a single woman until talking with her.

Nancy admitted that things were looking pretty good after the reconstruction, but the scars were still notable. I happily informed her that the world of scar therapy has immensely advanced, and laser treatment of scars has really been miraculous. Below I show one of the scars I treated that resulted from a skin cancer surgery. Nancy was so happy and hopeful once I let her know her options.

Creating hope for people is one of the best things I can do as a physician and friend.

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Laser scar revision following Mohs surgery. Photo: Dr. Jacquelyn Dosal

The second topic seems trivial compared to Nancy’s breast cancer journey, but it was definitely noticeable! Nancy had clear skin! Still battling with her acne in her 30s, she finally decided to proceed with Accutane (isotretinoin) — with unbelievable results. Instead of being distracted by deep cystic pimples, my eye instead focused on her beautiful smile, which is just so radiant and representative of her personality. As I examined her face, I was proud of my specialty of Dermatology, and I was proud of the often-vilified medication’s (Accutane) ability to remove self-consciousness from people who may be hiding their skin and face. No more cover up needed. It is truly one of the most powerful tools I have in giving people back their self-confidence. There is no reason to suffer from scarring acne when a miraculous cure exists for those who truly suffer. (That’s right, I didn’t say “dangerous,” I said “miraculous.” More on that later.)

Accutane B&A composite
Selfies taken by my patient during  her Accutane (isotretinoin) journey.

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I share Nancy’s story because she has truly inspired me. She keeps my troubles and worries in perspective — she reminds me to be grateful.grateful

I’m grateful for my health, family, and healthy skin. I’m grateful for my job as a dermatologist, a job that I love. I’m grateful for the chance to give others clear skin. I’m one of the few doctors that people actually like to see… I don’t make people take diabetes or blood pressure medication. People are usually motivated to use my prescribed treatments to improve their skin. It is the only organ system we can see with our eyes, and thus the benefits are often both somatic (of the body) and psychological. I love what I do, and I’m so happy to share it with others.

I was so refreshed and happy to see Nancy. Life’s a journey, not a destination, and Nancy is still on her journey for health, love, and fitness. On her way, she found clear skin, hope for her scars, and the best attitude one could ask for!

 

Dr. Jackie Dosal is a board-certified dermatologist in Miami, FL.  About Dr. Dosal: http://goo.gl/hbgqZW

#Getnaked. Check your skin!

I diagnosed two melanomas last week. My partner diagnosed another one the same week. Three melanoms in one week!!! Much to your surprise, here was the order of the most dangerous:
#1 most deadly case last week — melanoma on the bottom of the foot.
#2 most deadly case last week — melanoma on the lower leg.
#3 most deadly case last week — melanoma on the face.
Now, most of this has to do with how advanced the melanoma was when it presented, but there is an important lesson here. Alot of people will poo-poo a dark or unusual lesion on the lower body, since they don’t feel like the lower body gets alot of sun exposure.
Melanoma can happen ANYWHERE! The most common location for women to develop melanoma is the legs (as illustrated above — patients #1 and #2 were women).
I’ve said it before:

Screen Shot 2015-10-12 at 5.45.48 AM

If your dermatologist doesn’t make you #getnaked, find another one.

When you come to me for a full body skin examination, I check everywhere (unless you absolutely decline, I will respect your privacy!). But seriously, your dermatologist should be checking in between your toes, looking through your scalp, and checking where the sun doesn’t shine! I used to have a teacher in dermatology residency that would drill into us that if we weren’t checking the buttocks, we had not finished our full body exam. It was a little embarassing when she asked in front of the patient, but the point was well taken.
Bob Marley died of melanoma on his foot.
In truth, some melanomas are not sun induced (how would sun get to the bottom of your foot?), and these melanomas are more similar to other cancers that happen spontaneously. Therefore, everyone should come in for an annual skin exam, even people with dark skin.
I also strongly urge all of you to take a look at your skin regularly. Take a hand mirror and look ALL around before you get in the shower. Look at your spouse’s and your children’s skin. Become a “skin checker.”

What should I be looking for?

Dermatologists will often talk about the ABCDE method of detecting of melanoma. This is a great tool to help identify potentially suspicious lesions. Each letter corresponds to a characteristic of a mole that may signal an issue:

A stands for asymmetry — if a mole is asymmetrical. One half is not like the other half.
B stands for border — if the edges are ragged, not smooth.
C stands for color — if there are more than 1 or 2 colors present.
D stands for diameter — if it is more than >6 mm or the size of a pencil eraser.
E stands for evolution — if any mole is changing.

https://www.aad.org/spot-skin-cancer/learn-about-skin-cancer/detect-skin-cancer/what-to-look-for
https://www.aad.org/spot-skin-cancer/learn-about-skin-cancer/detect-skin-cancer/what-to-look-for

If you feel that any of your moles have met these criteria, don’t panic, but please do see your dermatologist for a professional evaluation.
As an aside, you should never feel funny going to the dermatologist to check any spot on your skin. The spot in question may be benign, but just being in the office may help identify other problem areas. More often than not, the worrisome spot is fine, but I may subsequently locate an inconspicious lesion that is a problem (potentially a skin cancer). This was the case in patient #3.
90% of melanomas are curable if caught early. Take care of yourself and your family — #getnaked and check your skin!