Dr. Dosal’s Favorite Things – for 2017

OK, so it’s a little too late for gifting, but never too late for giving yourself a fresh start to 2017!

If you are looking for a few new fresh ways to get your skin glowing, look no further!  I’ve got some of my favorite new discoveries that anyone can use!

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Heeere are some of my faaaavorite things!!! (Did that sound like Oprah?)

Eye cream with SPF
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It seems to be as much of an catch-22 as one might think.  The eye area is very sensitive so most people don’t put SPF around the eye due to stinging and irritation. Yet, the skin around the eye is the most delicate and vulnerable to UV damage.  Many women complain about crepiness around the eye area, much of which can be contributed to UV damage.  So why are we leaving the thinnest skin on our body completely defenseless against the sun?

Not anymore.  I’m so happy to be using Supergoop! Advanced Anti-Aging Eye Cream with SPF 47 every morning.  It has a cold metal roller that decreases early morning puffiness as well as some minerals that reflect light and make the eye area appear brighter.

Now, I’m definitely a product junkie, so, embarrassingly this is only 1 of 3 eye creams I use on a daily basis!  I also use  Teamine concealer that contains peptides, vitamin C, and licorice extract as my underage concealer (layered over Supergoop!).  At night I can’t live without my Neocutis Micro Eye cream (find Neocutis at our new Skin Associates Apothecary in Coral Gables!) – I recommend it to everyone!

Harness the power of nature – SNAILS! 🐌🐌🐌

biopelle-tensage50_largeIt’s all the rage in Korea.  Finally the US is starting to catch on.  Snails have the ability to easily heal themselves after encountering many injuries from the hazards of snail life – rocks, bacteria, etc.  Extract from snails contains growth factors, hyaluronic acid, peptides, glycolic acid, and other cell regenerating properties.  Snail extract has been reported to have anti-aging benefits, fade brown spots, tighten the skin, and increase “radiance,” a term that is difficult to define and measure.

I first tried Biopelle Tensage after receiving a sample at our annual dermatology meeting.  It looked like every other sample I had received, but this was the most impressive that I had ever used.  Within one week, I noticed a big difference.  I try so many products on a regular basis and it’s pretty hard to impress me, but the snails did!

If you are ever looking for a boost or a nice glow before a big event, use the potent Tensage 50 serum 1-2 times daily for a week, then once a week thereafter.  Tesage makes a daily serum that my patients also love!  Find them in our Skin Associates Apothecary!

Skin Detox

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Ever experience a skin freak-out?  Where your skin goes nuts for seemingly no apparent reason?  Usually it centers around travel, new skin-care products, or stress.  One in 5 people will experience an allergic reaction or irritation from a personal care product, so when these bad skin days/weeks occur, it’s best to strip down to only the basics… a skin “boot-camp!”  Rather than pitching all your products, check out this handy kit to get you through those rough days.  It is a kit that contains all your skin care products free of the 76 most common allergens, specially formulated for allergic people.  VMV Hypoallergenics is a leader in skin care for sensitive skin.  I refer all of my allergic patients to their website.  These products are also great for air travel, as they are small (TSA bonus points) and better than the fragrance-laiden soaps you’ll find in the hotel.

Anti-aging for your arms and legs

yj51czpn_201405022051428273Ever look at your grandmother’s arms or legs?  If she spent some time in the sun, then you might expect to see leathery texture to the skin, brown spots, dry skin.  Marketed as therapy for severely dry skin, DerMend’s Alpha + Beta Hydroxy Therapy is a one-two punch against both dry skin and aging skin.  It’s packaging is less glamorous than what can be found at the department store, but it’s an all-star treatment deserving of gold stars.  Alpha and beta hydroxy acids such as salicylic acid and glycolic acid help rejuvenate the top layer of the skin and also stimulate collagen growth with regular use, while simultaneously gently exfoliating off dry skin.  Note: be sure to wear sunscreen  when exposed to the sun while using this product and for four weeks afterwards.  Glycolic acid can make you more sensitive to the sun.  It’s well worth it (and you should be doing it anyway!) – my skin has honestly never felt so soft!

Ultherapy

before_after_ultherapy_results_full-face3As one of my nurses, Joan, puts it, Ulthera (Ultherapy) is the gift that keeps on giving.  Ultherapy uses ultrasound energy to lift and tighten the skin in a gradual process that gets better with time.  I experimented on myself (my neck) about 3 months ago.  While not overweight, I’ve always had a blunted angle from my chin to my neck, which has always bothered me.  Within a few months of having Ulthera done, I already appear thinner and have a more defined jawline.  It’s something I didn’t think was possible, and I’m thrilled!

Ulthera works best for normal weight individuals with good elasticity to their skin.  It does not replace surgery, but for those looking for a subtle lift, it does a great job!!  Check out http://www.ultherapy.com to learn more.

Clear and Brilliant

Clear and Brilliant (C&B) is a very light resurfacing laser treatment that almost anyone can have done.  Perfect for someone looking for a light treatment with almost no downtime, a series of Clear and Brilliant treatments can clear the complexion, lighten up dark spots, and give the skin a smoother appearance.  I find that sometimes people shy away from lasers because of the downtime needed.  C&B is perfect for the busy professional (or mom) who can’t take time off work (shuttling the kids) to recover from a laser treatment.

That’s all for now.  I’ll be sure to periodically update all of my favorite things!

 

 

 

Dr. Dosal Featured in Harper’s Bazaar

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Dr. Jacquelyn Dosal was featured in this month’s Harper’s Bazaar Australia.  Journalist Amy Molloy consults with Dr. Dosal about over-stretched concerns regarding sunscreen safety.

Molloy writes that women are skipping daily sunscreen use for fear of putting chemicals on their skin. This “chemophobia” is largely internet and celebrity driven, in contradiction to scientific studies that demonstrate safety and effectiveness of sunscreens.

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Dr. Dosal explains that the many of the assertions of toxicity come from lab animals that were fed sunscreen.  According to Dr. Dosal,

“There is a monstrous difference between eating super-high doses of sunscreen and applying it to your skin daily.”

To put it in perspective, it would take 200 years of daily sunscreen application to reach any amount of concern such as the scenarios found in the often cited rat studies.

If one has concerns, there are certain ingredients, such as zinc and titanium dioxide based, that are marketed as “chemical free,” (which really is a misnomer – everything is a chemical…. even water – remember H2O anyone?).

In summary, sunscreen not only prevents skin cancer, but it is also the best anti-aging ingredient on the market.  Don’t waste your time with fancy La Mer products if you aren’t wearing sunscreen every day!

Full article can be found here: harpars-bazaar-au-oct-16-health-sunscreen-new

Dr. Jacquelyn Dosal is a Board-Certified Dermatologist practicing dermatology in Miami, FL at Skin Associates of South Florida and is a voluntary Assistant Professor at the University of Miami.

 

I LOVE my Gel Manicures! But should I worry?

I LOVE my gel manicures!  Lasting at least two weeks, gel manicures have finally made my pincers look pretty!  Like many of you, I had been wondering about the safety about the UV lamps that are used to cure the gel manicures.  They seem fairly benign, but there has been some press questioning its safety. nail polish

When I read a recent issue of JAMA Dermatology, I was relieved to read that the authors concluded that the risk of skin cancer was very very low with gel/UV manicures, even with regular use.  This is what I suspected, so I stopped worrying.  Additionally, my salon recently introduced an LED nail lamp, which also seemingly solved the issue of the UV lamp.

Well, imagine my surprise when this topic came up again at the most recent American Academy of Dermatology Annual Meeting.  Nail expert Dr. Chris Adigun reopened my concerns about the safety of UV lights. She argued that the lamps are notoriously variable in their UV exposure, nail salons hardly ever follow manufacturer recommendations, and that the UV exposure is more than we previously thought.

This really left me conflicted, since I adore my gel manicures, and I really hadn’t prepared myself to abandon them anytime soon. So I took it upon myself to read through all the relevant articles on the subject (I hate taking someone else’s word for it).  Luckily, several groups have studied a variety of nail lamps, with a variety of hand positioning and exposure times.

Here’s the summary:

The amount of UV exposure is WAY below anything close to skin-cancer-causing levels.  

Here are a few other important take-away points:

  • Out of 72,709 women getting regular manicures for 60 years (assuming generous exposure times), only one woman would develop skin cancer who wouldn’t otherwise (in statistics, this is called the “number needed to harm”).
  • It would take 250 years of weekly gel manicures to equal that of a therapeutic phototherapy session that I commonly prescribe for psoriasis (15–30 treatments over 5–10 weeks).  (Yes, phototherapy is often UVB, rather than UVA, but this JID study measured UV dose in J/cm2, and gives a risk comparison to something we already know to be safe).

From a skin cancer perspective, the risk of skin cancer from nail curing lamps is very low.  However, it is important to note that ALL lamps used to cure gel manicures emit UVA radiation, even the LED lamps.  Despite the lack of “UV” in the name, LED lamps are actually more intense than UV lamps and emit more UVA.

As a quick review: 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 (and to a lesser degree than UVB, also contribute to skin cancer).

UVA UVB infographic
UVA penetrates deep into the skin to affect collagen and elastin, causing wrinkling, blotchiness, and poor skin tone.
UVA radiation is responsible for the brown spots (“liver” spots or “sun” spots) on your grandmother’s hands, as well as the wrinkles and crepiness of the skin.

There’s nothing worse than a youthful face that has been preserved with good skin care, but “old” looking hands.  

While the risk of skin cancer is much less than ambient exposure to natural sunlight, the cumulative effects of UVA exposure can result in discoloration and premature aging of the skin.

 

Aging hands
The typical appearance of a photoaged hand.  Note the blotchy appearance of the skin, brown spots, and thinned skin overlying the veins and tendons of the hand.  This occurs with regular exposure to UV light, especially UVA, which is emitted in all nail curing lamps and penetrates windows.
So your gel manicure won’t significantly increase your risk for skin cancer, but why risk any UV exposure?

For the very sake of preserving the youthful appearance of your hands, I recommend at least the application of a broad-spectrum sunscreen with an SPF of 30+ (see here for recommendations), or sun gloves while having your hands in the lamp.  My feeling is the gloves are better.

  • I use these sun gloves made by BloxSun– I wear them driving and bring them to the salon. 
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  • YouVee sunshields are currently crowdfunding – they are very cheap disposable hand protectors that block 99% of all UV radiation.  Wouldn’t it be great if salons started carrying these?
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In summary, I’m going to keep getting my gel manicures (thank goodness)!

For many of us women on-the-go, the gel manicure is here to stay!  Just be sure to protect those hands! And as with anything, it’s good to take a break once in a while from manicures to give your nails a breather.

Dr. Jackie Dosal is a practicing dermatologist in Miami, FL at the University of Miami and Skin Associates of South Florida.  

 

References

Shipp et al.  Further investigation into the risk of skin cancer associated with the use of UV nail lamps.  JAMA Dermatology 2014;150(7):775-6.
Diffey BL.  The risk of squamous cell carcinoma in women from exposure to UVA lamps used in cosmetic nail treatment.  British Journal of Dermatology 2012;167:1175-1178.
Markova A, Weinstock MA.  Risk of skin cancer associated with the use of UV nail lamp.  Journal of Investigational Dermatology 2013;133:1097-1099.
Macfarlane DF, Alonso CA.  Occurrence of non melanoma skin cancers on the hands after UV nail light exposure.  JAMA Dermatology 2009;145(4):4479.
Curtis J, Tanner P, Judd C, Childs B, Hull C, Leachman S.  Acrylic nail curing UV lamps: High-intensity exposure warrants further research of skin cancer risk.  J Am Acad Dermatol 2013;69(6):1069-70.
Dowdy JC, Sayre RM.  Nail curing UV lamps: Trivial exposure not cause for public alarm.  J Am Acad Dermatol 2015;6(64):e185-6.

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.

 

 

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.

journals stack
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!

glycation-of-collagen
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.  

twins
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.