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Derrick Adams
Stardust that has evolved to contemplate itself...
Stardust that has evolved to contemplate itself...

Beyond Sunscreen
A quick primer on things you can do in addition to wearing sunscreen
By Dr. Derrick Adams

Nicotinamide (Vitamin B3): 500mg twice daily of nicotinamide reduced skin cancer by 23% and reduced precancers by 13% in a very well done study that was published in 2015 (New England Journal of Medicine 2015 Oct 22;373(17):1618-26). Nicotinamide is not niacin and will not cause headache and flushing like niacin will. Be sure to avoid niacinamide and double check that you have nicotinamide. Niacinamide may cause flushing like niacin does. Nicotinamide is very cheap and should cost about a nickel a day.

Polypodium leucotomos: This is an herbal product from tropical regions that can be taken in pill form. It is sold under the brand name Heliocare in the US. Each capsule contains 240mg of standardized extract. To date, there has been no evidence it can prevent skin cancer but it has been proven to reduce sun burns. There are no known side effects. Shopping around for Helicare is worthwhile as prices can range for $17 to $30 a month. It should be taken once a day during the sunny months or as travel dictates.

Milk Thistle (Silybum marianum): Dermatologists at UC Davis have reported milk thistle seed extract has been effective in helping treat medical conditions that are exacerbated by sun exposure. There is no evidence it reduces skin cancer or sunburn in humans. The active ingredient in milk thistle is silymarin.

Beta Carotene: A study from 2008 demonstrated that oral beta carotene offered a mild benefit from sunburn. Participants had to take it for 10 weeks though before any benefit was seen. No evidence exists that it prevents skin cancer. The optimal dose is not known. A Finnish study of 29,000 smokers found that beta carotene increased incidence of lung cancer by 28% and all causes of death by 18%. I do not recommend beta carotene supplementation for sun protection.

Aspirin: The Women’s Health Initiative Study data was anaylzed by Stanford dermatologists and they concluded that daily 325mg aspirin reduced the risk of melanoma by 21% in women over a 12 year period. While that data is limited to older women, a more inclusive review of 11 published studies in 2015 suggests that “low dose aspirin” (less than 150mg per day) reduced all types of skin cancers in men and women. Asprin does have well known side effects and you should consult your doctor to find out if aspirin is safe for you.
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Air Pollution is Making You Ugly!
Dr. Derrick Adams
Board Certified Dermatologist

It is common knowledge that excessive exposure to the sun will age your skin. Dermatologists use the term “Photoaging” to refer to the havoc sunlight wrecks upon us. Now a German scientist has identified another enemy in our efforts to hold back time: Air pollution.

For decades air pollution has been known to contribute to heart and lung diseases. The World Health Organization (WHO) names air pollution “the largest single environmental health risk.” It is estimated 90% of all worldwide city dwellers are exposed to automobile fumes exceeding WHO guidelines for air quality. Researchers had not given much thought to the possibility that the body’s largest organ could suffer as well.

It makes sense that air pollution should cause skin aging given that our skin is our interface with everything around us. But it took the elegant study designs of the Professor Jean Krutman at the Leibniz Research Institute for Environmental Medicine in Germany to prove the theory.

“It is very clear that PMs (particulate matter aka air pollution) are a problem for the skin,” said Dr. Krutman. But he is just getting started unraveling the complexity of the issues. “I think air pollution has the potential to keep us busy for the next few decades”

His studies ranged from subjects in Germany to China. He recognized that Asians traditionally do not seek out tanning like Caucasians do, yet they often have just as many blotchy dark spots on the face. He knew there had to be another reason and suspected it was the heavy air pollution in many Asian cities. When the data was in, he observed that not only does air pollution cause dark spots but even minute worsening of the air spawns a disproportionate amount of dark spots. Dr. Krutman is promoting the idea that air pollution is the “major driver” for dark spots on the skin.

He was also able to demonstrate that women living closer to congested streets had statistically demonstrable more dark spots on their faces than women living a few blocks further away. Real estate agents take note!
Dr. Krutman also found that cooking indoors using solid fuels and exposure to chronic soot was associated with a 75% increase in wrinkling of the back of the hands as well as facial aging.

And it appears that different compounds wreck the skin in different ways. In addition to the dark spots, air pollution will degrade collagen, spawn wrinkles, and cause shallow blood vessels to spider web out right under the skin. Air pollution has even been shown to worsen hives, acne, and eczema.

So what can you do? I recommend people stop scrubbing their skin for starters. Scrubbing seems to be irrevocably baked into our culture and likely is the result of advertising campaigns forty years ago. The same goes for astringents or alcohol based toners that leave your skin feeling tight and crispy. Both of these destroy the barrier function of your skin by creating microscopic tears that let in bacteria. Now we realize it gives air pollution a free pass as well.

Companies are working overtime to find compounds that block air pollution. Someday soon your sunscreen will have added molecules to protect your skin from air pollution. Perhaps it will no longer be sunscreen but environmental screen? And how safe will these compounds really be? As we see with so many well intentioned efforts in medicine, there are very few biological free lunches.

Make no mistake: the sun still causes premature aging, dark spots, and skin cancer. You should take steps to mitigate these risks. Dr. Krutman’s research is another fascinating piece of the puzzle.

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Does Trump's hair suggest an underlying medical condition?

By Dr. Derrick Adams

We have heard all the jokes about President-Elect Donald Trump’s hair issues. Does he wear a toupee? Was there a botched hair transplant surgery? Is it possibly the worst comb over in history? Anyone taking a cheap shot at Trump always goes straight to the hair.

But does Donald Trump perhaps have a legitimate medical condition that explains his crispy crown? Believe it or not, dermatologists have recognized a condition called Uncombable Hair Syndrome (UHS) since the 1970’s. While harmless, it causes the hair to take on a silvery blond or straw-colored appearance; often frizzy and disorderly despite attempts at grooming. Sound familiar?

Typically a child diagnosed with UHS will start showing signs around age three. Most resolve spontaneously right before puberty but there are reports of persistence into adulthood. Only about 100 cases have ever been reported but there are likely many more people with UHS out there. After all, when was the last time you went to the doctor for a bad hair day?

Historians believe that an individual with UHS inspired a famous 1845 German children’s tale of Struwwelpeter, aka, “Shockheaded Peter”. Always a good eye for fun, Mark Twain later translated it into “Slovenly” or “Shaggy Peter” for American readers. Recently the German version was translated into a dark opera about misbehaving and disheveled children. Spoiler alert: All the children die.

Last month, scientists discovered three genes that are responsible for UHS by frazzling the hair during development. While normal hair shafts are circular, the affected hairs of UHS are heart-shaped or triangular when cut in cross sections. This makes the hair less pliable and stiffer. The irregular surface reflects light differently and lends it a shimmery appearance. It is also described as “spun glass” looking.

So what is our evidence that our soon-to-be president has this condition? Well nothing really. I believe Trump has just let his hair too long in an attempt to recapture its previous thickness. His hair style has been the same for decades and is likely part of his branding at this point. Whatever hair dye he uses seems to create the characteristic “spun glass” luster. His nature hair color was brown at some point further arguing against it. Childhood photos I was able to locate online also seem normal as do his other family members.

Doctors and historians love to debate which famous figure has, or had, which diseases. After combing through the evidence, it would appear he does not have UHS. Modern science will again have to go back to the drawing board to explain the strange situation on our President-Elect’s head.
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The Creepy Tale of Human Leather, Nazi Lampshades and Nipples.
By Dr. Derrick Adams
Board Certified Dermatologist & Halloween Aficionado

In the spirit of Halloween, I offer you a tale of pure dermatological suspense: Leather made from human flesh.

Humans have probably been skinning each other and doing various symbolic acts with the hides forever. Ancient Assyrians were known to fillet their enemies and drape the skins from their walls. But there is no agreed upon story on when and where someone first decided to literally wear and walk in someone else’s skin.

After WWII, the sadistic wife of a Nazi commander at the Buchenwald concentration camp, was sentenced to prison for orchestrating the harvesting of Jewish skin to make lampshades. A war crimes tribunal later dismissed these charges, unable to prove she had any items made of human skin. Despite this, both Soviet and American soldiers all attested to having seen many decorative Nazi items made from human skin during the liberation.

After the floodwaters of Hurricane Katrina had receded in New Orleans a lampshade mysteriously surfaced that was claimed to be not only made from human skin but from the collection of the infamous Nazi woman. National Geographic produced a riveting investigative television program about it available online for free viewing.

The practice of binding books in human skin, Anthropodermic bibliopegy, has a long and storied tradition. There are less than fifty of these historic works in existence and all are highly coveted items by libraries and private collectors of the macabre. Famous textbooks of anatomy have been bound in the flesh of the dissected cadavers. Executed criminals have had their skin used to bind the legal records of their case. And a centuries old book of erotica is cloaked in the tanned breast skins of several women-complete with intact nipples.

Even today, an online company from the UK advertises a wide selection of goods made from human leather. They are secretive about their processes and sourcing—stating all ‘donors’ are well compensated. They claim their trade is legal but they do suffer “official hindrances along the way”. So what does a human leather belt cost? About $15,000 through this company. A good old sturdy human wallet will set you back a mere $7,000.

In 2010, fashion designer Alexander McQueen passed away at age 40. One of his early brands actually called “Jack the Ripper Stalks His Victims” included small hair samples from Mr. McQueen in its design. Now student designer Tina Gorjanc is attempting to utilize those hair samples and culture Mr. McQueen’s skin in a lab to create a line of jackets, purses, and hand bags. The proposal even includes adding reproductions of Mr. McQueen’s freckles and known tattoos to add authenticity.

Just when you think wearing a jacket of human skin could not get any creepier, U.S. patent law enters the picture. Ms. Gorjanc shared that she was able to create and patent the collection because legislation does not limit the commercial usage of human genetic material. Gorjac is quoted on her website: "If a student like me was able to patent a material extracted from Alexander McQueen's biological information, we can only imagine what big corporations with bigger funding are going to be capable of doing in the future."

We all remember the words of Atticus Finch in To Kill A Mockingbird, “You never really understand a person until you consider things from his point of view …until you climb into his skin and walk around in it.” Well for the right price, you may be able to understand a lot of people evidently.

Dr. Victor Frankenstein was not available to comment unfortunately.

Happy Halloween everybody and thanks for reading.
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How Dirty is Your Handshaking Habit?
by: Dr. Derrick Adams
Board Certified Dermatologist and Hand Shaker

It is campaign season. Time for greasing the palms and shaking hands—an ocean of sweaty, germ-ridden, open hands just waiting to “press the flesh” with a candidate.

You probably have heard by now that presidential candidate Donald Trump does not shake hands. In his 1997 autobiography he laments that “the more successful and famous one becomes the worse this terrible custom seems to get.” You may be surprised to learn that George Washington also shared Donald’s viewpoint. When presented with an open hand President Washington would respond, “Sir I do not take the hand” and reportedly offer a slight bow in respect.

Are handshakes on the way out? A few years ago, the Journal of the American Medical Association called to ban handshakes from hospital environments. With rising rates of hospital acquired infections, pressing palms together is an unnecessary risk. A study in the American Journal of Infection Control revealed a fist bump transferred only one-twentieth of the germs of a handshake. And a good old high five only transmitted half the germs. 

Personally, I don’t see much fist bumping going on in healthcare. And a bunch of doctors high fiving each other in the hospital would certainly raise eyebrows. Imagine this scenario: “Hello Mr. Smith I’ll be your cancer surgeon today. Now give me some knuckles!”

Some leading infectious disease experts suggest health workers eliminate all but the most essential contact with patients. This means no handshakes, no hugs, and even no fist bumps. But sometimes all a lonely patient needs is a little personal contact to reconnect them to humanity.

It is probably only a matter of time until we bow to each other as in many Asian customs. Maybe we are one good pandemic away from this being the new normal?  But Americans are a touchy feely bunch most of the time. This will be a tough, if not impossible, transition. 

President Obama has already largely adopted the fist bump. Would a Trump presidency move us one step closer to shunning handshakes?

I once met a man in the wilderness of Colorado that insisted we shake with our left hands. “The left hand is closer to the heart,” he explained. I have always remembered that handshake and tried to make each one a warm and disarming gesture going forward. A handshake is your physical signature in a way. And although it can convey an ocean of meanings, it can also transmit an ocean of bacteria.

To shake or not to shake? That is the question. And I have no answer. 
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Itching from Poison Oak? Poison Ivy? 
Are you just itching? 
Give Sasquatch Itch Cream a try this year. 
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Bug Spray: No Mercy for Mosquitoes 
by Dr. Derrick Adams
Board Certified Dermatologist and Hater of Mosquitoes

Here in California, we all welcome the March rain we have been getting. But coupled with the warmer temperatures this winter, I fear we may be in for a bad mosquito season. The human buffet will be open shortly. With all the headlines about the dreaded Zika and West Nile virus, people will be stocking up on insect repellent quite soon. 

But what to buy? 

 We are all familiar with old fashioned DEET. It has been around since World War II.  In response to consumer fears surrounding DEET, companies have scrambled to come up with a safe alternative. There seems to be as many mosquito repellents as there are mosquitoes these days. And few head-to-head studies have been done to any large degree. 

If you are a regular reader of the Journal of Insect Science, you are probably familiar with the study conducted at New Mexico State University recently. They tested 10 available products against two common species of mosquitoes. Three products contained DEET (Repel 100® Insect Repellent, OFF® Deep Woods Insect Repellent VIII, and Cutter® Skinsations Insect Repellent). Four products were more natural based without DEET (Cutter® Natural Insect Repellent, EcoSmart® Organic Insect Repellent, Cutter® Lemon Eucalyptus Insect Repellent, and Avon® Skin So Soft Bug Guard). And then three seemingly random products were tested (Avon® Skin So Soft Bath Oil, Victoria's Secret® Bombshell perfume, and Mosquito Skin Patch®)

The results: The researchers reported that all the tested mosquitoes were “strongly repelled” by products containing DEET and lemon-eucalyptus oil. For the other products, they found mixed results. And it seems the Mosquito Patch is not worth your hard earned money. 
"Overall, the results from this study confirm that DEET repellents are the most effective mosquito repellents in the market,” reported the authors. “Although, based on the results from this study, a lemon-eucalyptus oil containing p-menthane-3,8-diol has similar efficacy to DEET repellents."

Strangely enough, Victoria's Secret® Bombshell perfume is also good at repelling mosquitoes. While DEET held its repellent effect for over 240 minutes, Victoria’s perfume was effective for 120 minutes-giving a lady a good reason to reapply while outdoors. 
Picaridin and permethrin are also very effective and safe compounds. They were not included in the mentioned study but have been validated elsewhere. Permethrin is used to treat inanimate objects like your boots or tent. 

Keep in mind that there is good data for using DEET as tick repellent also. Unfortunately we cannot apply the study’s mosquito data to ticks. As one is a true insect and the other is an arachnid (more closely related to spiders), the non-DEET products may not offer as broad coverage. I am all for “safer” and more “natural” when possible. But West Nile Virus and Lyme’s disease has kept me using DEET or Picaridin year after year. Now the lemon-eucalyptus oil seems like a great choice also. I suppose I could also treat my tent and hiking boots with permethrin but I’m either too lazy or not sufficiently paranoid. 

Sometimes it feels like we spin our wheels in medicine. As a dermatologist, I advise people to stay out of the midday sun but enjoy the mornings and evenings. Sounds like good advice right? Until you hear the CDC’s radio ad telling you exactly the opposite. In order to avoid mosquitoes, they want you going out during the midday. Blasphemy! But I’d like to propose a third option: Go out when you want and live life. Just remember your bug spray and sunscreen. And if you ever catch me in Victoria’s Secret…I am just buying my insect repellant! 
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A Medieval Spell to Treat Staph? 
by Dr. Derrick Adams
Board Certified Dermatologist & Slayer of Staph

     The past decade has seen Staphylococcus bacteria become a public health hazard. Mankind’s once seemingly limitless dominion over bacteria is no more. Bacteria, especially Staph, continue to chew through our existing antibiotic supply and our research pipeline cannot keep up. 

     It is high time to dust off the old play book—an eleven century year old playbook.  

     The earliest know Anglo-Saxon medical text is Bald’s Leechbook. It was composed sometime around the 8th or 9th century for a man named Bald and survives to this day. It records many Old English remedies a healer of that day could call upon. Treatments for male impotence, cough, aching feet, and headaches are found alongside potions to aid men in tolerating women’s ceaseless chatter. 

     For a thousand years we have ignored this work, relegating it only to a historical curiosity. After all who would believe elves and dragons could be behind your gouty toe? Some curious researchers from the University of Nottingham and Texas Tech University thought differently and decided to test Bald’s ointment for styes (Staph infections of eyelashes).  What they found was remarkable. 

     The recipe called for garlic, leek, honey, wine, onion, and fresh bile from a slaughtered cow. Bald evidently did not feel listing the exact type of wine to be of importance and some of the vegetables grown today differ slightly from a thousand years ago. Luckily the researchers were well versed in Anglo-Saxon history and deduced the correct formula.  The two scientists are part of a club that re enact Middle Age mock-combat by donning armor and, with blunt weapons, beat each other up in a local park. Did I fail to mention the two scientists are women? 

     When they initially tested the ointment against Staph in the lab, they were dumbfounded. Ninety percent of the bacteria perished. They also tested the components separately and destructed the recipe to no avail.  Only when following the Leechbook formula did the researchers continue to kill ninety percent after ninety percent of the bacteria. 

     They next pitted the ancient cure against the dreaded MRSA (the infamous drug resistant Staph). MRSA did not exist until a few decades ago. Surely a thousand year old remedy would wither before the might of this modern killer. But when they checked their Petri dishes the next morning, another ninety percent kill rate was tallied. Bald’s remedy had gone Beowulf on the Staph!

     But despite sending legions of Staph to the halls of Valhalla, there is one foe it likely cannot slay: The FDA. As impressive as a ninety percent kill rate sounds, the regulatory hurdles and lack of big money champions will likely keep this out of mainstream medicine. But if we ever do eventually exhaust our antibiotics, it would be foolish to put the recipe back on the shelf to collect dust. 

     A nineteenth century translation of Bald’s Leechbook is available online for the curious. Who knows what other hidden gems are waiting to be rediscovered? And for those of you wondering about that cure for a chattering woman, here it is: ‘Against a woman’s chatter; taste at night fasting a root of radish, that day the chatter cannot harm thee.’ 

Good luck gentlemen. 
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Allergies and Your Skin: It is more complicated than you can imagine!

By Dr. Derrick Adams, DO, FAOCD
Board Certified Dermatologist & Skin Geek 

In case you missed it, the 2015 Contact Dermatitis Allergen of the Year Award goes to… formaldehyde!”  A chemical commonly found in nail polish and the popular Brazilian Blowout hair straightening treatment. Formaldehyde is also a common embalming fluid but the cadavers don’t seem to be complaining. 

Yes America. We have a Contact Allergen of the Year Award. It is awarded by the American Contact Dermatitis Society. This group of dermatologists and allergists meet each year and enthusiastically crown one lucky molecule which has wrecked such havoc with people’s skin to be worthy of infamy. Some recent past winners include nickel, fragrance, and even gold. At least these are the easy ones to pronounce. Methylisothiazolinone, benzophenones, and mixed diakyl thiourea are also past winners. 

Allergic Contact dermatitis arises when your skin becomes allergic to something with which it comes in contact. This differs from an irritant contact skin rash where the skin is simply broken down by caustic chemicals (think bleach) or from aggressive hand washing. The classic allergic contact dermatitis is poison oak. And when it comes to contact allergies of the skin, “Anybody can become allergic to anything at any time.” A phrase I find myself uttering daily. 

“But I’ve never been allergic before!” people exclaim defiantly. I try to gently point out that we human beings are not born with all the problems we will accumulate in life. There is a first time for everything in life—contact dermatitis included. Contact allergies can happen to anyone regardless of how “allergic” they feel they may be. Often people believe that something has changed in their product to elicit the rash. That may be true. But it is also possible you have changed and the product has stayed the same. 

The immune system in your skin is constantly analyzing things you come in contact with. The metal in the rims of your glasses. Your shampoo and hair dye. Your keyboard. That potpourri air freshener you spray in the bathroom. Millions of tiny particles from your environment contact your skin every day. Allergic contact dermatitis almost is always from something your skin has encountered countless times before. You may have used that same shampoo for thirty years, and then one day you develop a rash to it. Your immune system catalogs all these molecules and forms a memory of what it deems good and bad. And when your skin mistakes these molecules as ‘bad’ it mounts an attack. So while your immune system is showing that pesky fragrance molecule who is boss, you are suffering with an itchy rash. 

The top contact allergies I see in my practice are to Neosporin (or knockoff brands), nickel (body piercings, watches, jewelry), fragrances (about every product you own), hair dye (sorry ladies), and of course, poison oak. Shampoos, soaps, nail polish, hair sprays, and scented candles are not uncommon either in my experience. Allergies to baby wipes are also increasing as more adults are starting to favor these. 

Testing for contact allergens is difficult. Many labs promote the use of blood tests by looking for levels against specific allergens. This is fantastic for your hay fever and asthma triggers but a very poor test for skin allergies. Skin allergies are a completely different mechanism, and require the potential allergens to be placed on the skin to elicit a response. Usually a patch impregnated with various allergens is placed on the skin and then read in a few days. These types of tests are time consuming and have only a moderate yield in my opinion. It is simply impossible to test your skin against everything it comes in contact with during your day. And just like the blood tests, a positive result does not always equate to a smoking gun in explaining your rash. Still, this type of testing can be valuable in ruling out what products are not the culprits. Occasionally the tests are useful and life changing for people.  

So get ready and roll out the red carpet for next year’s Contact Allergen of the Year. Assuming that is you are not allergic to the carpet cleaner, the fabric, or the red dye. 
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