Vitiligo is a skin condition characterized by white spots on the body. It can occur anywhere on the body but is very common on the face and hands. This is the skin condition that Michael Jackson reportedly suffered from. Vitiligo occurs in all skin types but is most obvious in people with multi-hued skin tones because of the striking contrast in color between the white and brown skin.
A recent study examined bimatoprost ophthalmic solution (Latisse) in 10 patients with vitiligo. Patients applied the solution twice daily for four months to the affected white vitiligo spots. Three patients had 100% repigmentation, 3other patients had 75-100% repigmentation and 1 patient had 50-75% re-pigmentation. Overall 7 of the 10 patients responded to treatment. Patients with vitiligo on the face responded the best.
The big question is …why does Latisee work on vitiligo? Well Latisse is a prostaglandin that is known to increase melanin production. Before it was used for eyelashes, it was a glaucoma medication. In the original glaucoma studies, one of the side effects was increased iris pigmentation. So it is not surprising that Latisse may work in vitiligo. Of course more studies are necessary to truly understand the role of Latisse in vitiligo, but it certainly looks promising.
Summer is upon us and this is the time of year when patients often come in complaining of “sun spots”. This is one of the most common things I see in the summer but its official name is tinea versicolor. Tinea versicolor is seen in young men and women and is characterized by slightly scaly spots on the back. It can also occur on the chest and abdomen in more severe cases.
In darkly pigmented people, tinea versicolor is usually lighter than the normal skin. In lighter skinned individuals, it can be tan or slightly darker than the surrounding skin. This familiar skin condition goes by many names…“sun spots” and “acid” are two of the most common ones. There is a wide held belief that they are caused by the sun, or drinking soda and juice. The truth is that tinea versicolor is caused by a common fungus. Some people relate it to the sun because sometimes the fungus produces a chemical that prevents tanning in the affected areas. For this reason, when you go out in the sun, the affected areas do not tan and are lighter than the surrounding skin. Thus, the name “sun spots” was a logical misnomer.
The treatment is simple. Ketoconazole is an antifungal medication that is taken by mouth or used in a topical cream or shampoo to treat this condition. Tinea versicolor tends to be recurrent so sometimes prevention with a weekly antifungal soap or even Selsum Blue shampoo is recommended. So if you suffer from sun spots, there is no need to worry. This is a common condition that can be easily treated by your dermatologist.
Memorial Day weekend in South Florida was hot! Unfortunately, I wasn’t where all of the action was in South Beach. I was actually invited to speak at the annual meeting of the Florida Society of Dermatology and Dermatologic Surgery in Boca Raton. I spoke about hyperhidrosis.
Hyperhidrosis is excess sweating and is common on the hands, underarms, feet and even in the groin. It almost always gets worse in the summer so I thought it would be a good time to shed some light on this condition and treatment options. If you suffer from hyperhidrosis, you are not alone. Around 2.8% of people have hyperhidrosis. It tends to run in families and can start in childhood. Most people grow out of it but for some it can persist into 30’s and 40’s. Antiperspirants that contain aluminum chloride are the best first line treatments. HydrosalPro is an excellent new product from Canada that has worked well on many of my patients. Antiperspirants with aluminum chloride are actually used at night so that they can penetrate better and clog the sweat ducts. Usually they are applied nightly for 4-7 nights and then as needed.
If topical antiperspirants don’t work, Botox injections are another excellent option. Some insurance companies cover the procedure and Botox typically stops sweating for 3- 6 months. For severe cases, there are also two surgical procedures to treat hyperhidrosis. One involves liposuction of the sweat glands in the underarms and is a permanent safe solution. The other procedure is called sympathectomy and is a more significant surgery that cuts the nerve that causes sweating of the hands. Although this procedure is very effective, up to 30% of people get sweating in other locations so there are significant risks involved.
For anyone with hyperhidrosis, I always recommend the website sweathelp.org. It has tons of detailed information on all of treatments I discussed today. If you have hyperhidrosis, don’t get discouraged this summer. There are many treatment options available…you just have to find the one that works best for you.
Recently I was at an outdoor event and walked by a temporary tattoo stand. It looked like fun and was “temporary” so many people were lined up to get inked. These temporary tattoos are also known as black henna tattoos and vendors typically explain that they will wear off over several weeks.
Interestingly, as a dermatologist I have seen many reactions to these tattoos that range from mild itching to severe blisters. Those with the most severe reactions can actually heal with scarring. When I first saw these reactions I was surprised because henna is a natural vegetable dye and has been used for centuries; however, the truth is that black henna tattoos also contain para-phenylenediamine (PPD) which is a black dye. Authentic natural henna tattoos are actually orange/brown in color and need to be left on for hours to stain the skin. They rarely cause any type of allergic reaction.
Vendors often add PPD, to the natural brown henna because it stains the skin more quickly (within ½ hour) and looks darker like a real black tattoo. This black dye is the same ingredient in black hair dye and is a common cause of contact dermatitis in people who are allergic. In hair dyes, the FDA requires that the concentration of PPD is less than 6% due the significant risk of allergic reactions to this ingredient. In some of the black henna pastes used for tattoos, the concentration of PPD can range from 10%-80%.
So how can you know if a temporary tattoo has PPD? It is simple… if a paste stains skin black in less than ½ hour, it has PPD in it. Also if the paste is mixed with peroxide, or if peroxide is wiped over the design to bring out the color, it has PPD in it. It is best to avoid these temporary tattoos unless you are 100% sure they do not contain PPD…otherwise, if you are allergic, these tattoos may not be so temporary after all.
The Brazilian blowout goes by many names (i.e “Brazilian Keratin Treatment” and “Keratin Hair Treatment” just to name a few). These products involve applying a keratin solution to hair to seal the cuticle resulting in smooth, frizz-free tresses.
There are so many of these treatments on the market, it is hard to figure out which ones are safe. Well, here is a little history on this increasingly popular hair trend. The original keratin treatments from Brazil had very high concentrations of formaldehyde. The treatments were so toxic that they had to be performed next to a window with masks and a fan to prevent inhalation of the formaldehyde. Unfortunately, a young woman in Brazil actually died after one of these treatments.
When keratin treatments arrived in the United States a few years ago, the FDA was quick to attempt to regulate these products and banned all products that contained higher than acceptable levels of formaldehyde. The problem is that formaldehyde makes the hair straighter so manufacturers are tempted to increase the levels to get better results. In fact, last month the US Occupational Safety and Health Administration (OSHA) announced that these treatments “can release unsafe levels of formaldehyde, posing a risk to salon workers and customers.” OSHA officials also said they found formaldehyde in many hair products that are labeled “formaldehyde-free” and are now investigating complaints about the products.
So what should you do if you want to try a keratin treatment? Well first you need to look for products that are labeled formaldehyde free. Make sure you read the bottle yourself and don’t just rely on what the stylist says. But you must keep in mind that even if it says formaldehyde free there is a chance that it still contains formaldehyde. The good news is that formaldehyde has a very strong odor and it should be pretty obvious if the fumes are strong. The other good news is that the FDA and other agencies are really cracking down on illegal products so they could be cleared off the market soon. Remember to be vigilant, because it simply is not worth it to risk your health in an attempt to get straight hair.