Right now your hands are teeming with bacteria. Countless trillions of organisms call your skin home, and that’s a good thing. Skin infections do not arise because you have bacteria on your skin. Rather, they arise because the type of bacteria on infected skin is not healthy bacteria but aggressive pathogenic bacteria.

Determining which bacteria are good and which are dangerous is difficult, but our immune systems have managed to get it right most of the time. When our immune systems are wrong, either an infection develops, or excess inflammation develops, as is the case in eczema or psoriasis.

Telling good from bad is hard. There are hundreds of types of bacteria on your hands right now. A recent study of college students (perhaps not the cleanest group of individuals) discovered that the average student has 140 different types of bacteria on his or her skin. There were over 4,000 different types of bacteria identified across all the students. Not surprisingly, the most common types were familiar household names: Propionobacterium (the bacteria responsible for acne), strep, and staph (of which the infamous methicillin resistant staph aureus, MRSA is a subtype).

There were also differences in the bacteria on the dominate hand versus the non-dominant hand — namely bacteria normally found in the gastrointestinal track was found more often on the dominant hand. This will no doubt lead to a follow up study of: “Do college students wash their hands before leaving the bathroom?” (Research so far does not look promising).

Photo: Pink Sherbert Photography (flickr)

So how does a dermatologist like me protect against skin cancer? I go to Peet’s Coffee.

There are plenty of reasons to enjoy a cappuccino in the morning (if you can still afford it), and preventing skin cancer might be one of them.

Studies of mice have shown that feeding them caffeine protects them against ultraviolet radiation, which is similar to sun exposure for humans. The protection is most effective when the mice exercise. (So the researchers basically make them drink espresso then hit the exercise wheel.)

While epidemiologic studies and animal studies are helpful, it is nice to have a scientific explanation to support the claim. New studies show how it works.

Researchers exposed skin cells that were growing in culture to caffeine (possibly when one of the graduate students spilled his Red Bull on the petri dish). They then exposed the cells to damaging UVB light. They found that the caffeine-treated, UV-damaged cells underwent programmed cell death. When cells are damaged, but don’t die, they grow into cancerous tumors. When damaged cells die, they are no longer a threat to the body and are safely eliminated.

As sunscreens become more sophisticated, ingredients like caffeine will be added to soak up the damaging oxidants or to protect the skin from developing cancer. Botanicals like ferulic acid, derived from ferns, have proven themselves as powerful additives to sunscreens and are the future of sun protection.

Although there is not enough evidence to advise patients to drink more coffee as a means of sun protection, do you really need another reason to have a nice macchiato in the afternoon?

Photo: Burnt Phrases (flickr)

You might be getting some UV exposure long after the sun goes down — some new fluorescent light bulbs give off UV light.

Fluorescent light bulbs are everywhere now that people are trying to be more green. Most popular are the ice-cream-twist compact fluorescent bulbs called CFBs. CFBs create light by energizing a gas and exciting a phosphorous coating on their glass. The coating prevents most of the ultraviolet light from reaching you, but not entirely; some UV radiation leaks out of any fluorescent bulb. In some CFBs, the emission of UV light is so high that it exceeds the safety limits of the International Commission of Non-Iodizing Radiation.

So, should you be applying sunscreen before turning on your CFB reading light at night? No. Nor should you switch your CFBs back to energy wasting incandescent bulbs. The amount of UV exposure that you get from the light bulb is small compared to the UV exposure you get from just being outside; for most people it is not significant.

However, some people are exquisitely sensitive to ultraviolet light. Auto immune diseases such as lupus, inflammatory disease such as rosacea, and certain drugs such as HCTZ can be triggered by even small amounts of UV light from CFBs.

If you are particularly sensitive to UV, then select CFBs that have a double envelope instead of single, as it will block most of the UV light. And always stay at least one foot away when using fluorescent bulbs of any sort.

Also, remember to sit back from your TV (which my mother taught me to do when I was a kid). Of course, now with HDTVs, you get the best picture when you’re sitting a distance of 3 times the diameter of your TV. If you just bought a 60 inch HDTV, you might need to be in your neighbor’s living room to watch it. This, fortunately, should be safely away from any radiation.

Photo: Steven Fernandez (flickr)

Showering daily is a modern-day cultural behavior. Although it has some advantages (reduces unpleasant odor) it also has disadvantages (strips natural oils from your skin).

I have patients, usually men, who use their shampoo to wash their body. Although convenient, this is a bad idea. Shampoo is “soapy;” that is, it’s designed to remove oils and buildup from your hair. This soapiness also strips oils off your skin. Shampooed skin will be left dry, dull, and susceptible to irritation. Dry, vulnerable skin is the main cause of winter itch. Remember these tips to be good to your skin this winter:

1. Never use shampoo to wash your body.

2. Let your shampoo rinse out of your hair while leaning forward, trying to prevent the shampoo from running down your whole body.

3. Never use a soap that makes “bubbles” in the shower or bath, it will strip all the oils off your skin.

4. Use a non-soap cleanser such as Dove.

5. Apply a body moisturizer immediately after showering, while your skin is still damp. This will lock in the moisture that has soaked into your skin, and keep your skin hydrated and protected all day.

Photo: Ted Blog

Well you can add flip-flops to the list — I’m sure my mother is throwing hers away right now.

Before you toss them though, let me clarify. It is not your flip-flops that cause cancer. In fact, I’ve not seen any studies linking sandals, tongs, flip-flops, or any other foot wear to skin cancer. There are good studies however, which show that sunburns increase the risk of skin cancer, and those glowing-white feet that have been protected in shoes all year are now at significant risk in sandals.

How many of you have had a foot sunburn? Most of us have. That’s because we usually apply sunscreen to our face, arms, neck, and legs but neglect to apply it to the tops of our feet.

Wearing flip-flops exposes the tops of your feet to direct sunlight, significantly increasing your risk for developing a sunburn. Wearing flip-flops will not cause cancer, but getting a blistering sunburn on your feet every summer might.

Remember that because your feet have not seen the sun much for most of the year and are perpendicular to the sun’s rays, they are particularly vulnerable to sun damage. Apply a broad spectrum sunscreen with SPF of 30 when you put on your flip-flops. You’ll thank me later.

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Sunscreens have a self life of about 3 years. However, most sunscreens are unstable at high temperatures (ironic, huh?). High temperatures can cause the ultraviolet absorbing chemicals like avobenzone and oxybenzone to degrade right in the bottle. When you apply a degraded sunscreen to your skin, you are not getting the SPF indicated on the bottle and in fact might be applying nothing more than a thick white moisturizer. Ideally sunscreens should be kept at temperatures no hotter than 77 °F (25°C) — the inside of your car in the beach parking lot can reach over 120° (50°C).

When you are at the beach, toss your sunscreen in the cooler; it will keep it from breaking down and will feel great on your skin when you reapply.

If you have an sunscreen that is more than 3 years old or a sunscreen that has been sitting in your car for any length of time, then buy a fresh one this summer. Otherwise, you might need this.

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What are cold sores?

Cold sores are a herpes virus infection. Yup, that’s the same as genital herpes, but usually a different strain of virus. Type 1 herpes prefers the mouth, and presents as a group of blisters on the lips — a cold sore or fever blister. Type 2 herpes usually infects the genitals and surrounding area. The viruses are particular about where they infect but not exclusive — it’s possible to get a type 2 herpes virus infection on your lips or to get a type 1 virus infection on your genitalia.

The initial infection is generally the worst; in oral herpes, fast developing, painful blisters form on your lips and in your mouth within a week of being infected. The blisters crust over and form scabs which take a week or so to heal.

Once the virus infects you, it is yours for life. It will live dormant in the nerves of your lips and face. In some people a second outbreak never occurs. However, in most people, the virus reactivates on seemingly random occasions, leading to an uncomfortable and unsightly outbreak.

Outbreaks start as a red, swollen spot on your lips. The patch of skin usually feels numb or burns for a few hours before any changes appear on your skin. Then fluid filled blisters develop, which break within hours, leaving a crusted scab for days.

How is herpes simplex diagnosed?

Seeing the outbreak is usually enough to diagnose a herpes virus infection, but it can be confirmed by a blood test, a culture, or a direct florescent antibody (DFA) test.

How do you get a cold sore?

It’s a virus, so you catch it like any other virus – from someone else with a herpes infection. It’s highly contagious though, and most people get it in childhood from close contact with an infected family member.

You can get cold sores by kissing someone who is infected. Though the virus is more contagious when you have an outbreak, it is possible to infect people (or to get an infection) even when there is no visible outbreak.

Outbreaks are triggered by many things including sun exposure, stress, fevers, illness, certain medications, injuries, laser treatment, chemical peels, fillers, and even Botox.

How do you treat cold sores?

The initial infection is the most important to treat. It is the most severe and usually involves the inside of your mouth (recurrent outbreaks are usually on a limited area on the outer lips).

Herpes can be treated with topical antivirals such as Abreva (available over the counter) and by oral antivirals such as acyclovir (Zovirax) or valcyclovir (Valtrex). Unfortunately both the topical and oral antivirals do not cure cold sores; rather, they shorten the the course by a few hours to a day or so. It’s important to start treatment at the first sensation of an outbreak, before there are any visible changes on your skin.

How do you avoid cold sores?

• No kissing. OK, so maybe that is not an option. In truth, try not to worry about it. The virus is very common and highly contagious. Certainly if you have an active outbreak you shouldn’t touch it or kiss anyone until it has healed completely. You may be the world’s greatest kisser, but you’re not so irresistible that someone can’t wait a week for that fever blister to heal.
• Once you have been infected, there are ways to minimize outbreaks. Because cold sores can be trigged by ultraviolet light and chapped lips, apply a lip balm with a 30 SPF sunscreen, especially before heading out to the beach or snow skiing in the winter.
• Lip licking can lead to irritated lips and to an outbreak of oral herpes. Apply a protective ointment like Vaseline and try to break yourself of the habit.
• Some people have such frequent outbreaks that they need to take an oral antiviral medication, such as acyclovir. This has been shown to decrease the occurrence of oral herpes, but at the expense of having to take a pill everyday.
• Although usually a self-limited condition, herpes can cause a severe, widespread infection in rare instances. This occurs when the skin surrounding the outbreak is disrupted as happens in people with eczema (atopic dermatitis), or following a facial laser resurfacing or chemical peel. This is why patients take an oral antiviral medication before having facial resurfacing to prevent such an outbreak.

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Although most hand gels claim to kill 99.9% of harmful germs and bacteria, hand sanitizers with less than 60% ethyl or isopropyl alcohol are not effective. In fact, using an alcohol sanitizer with only 40% alcohol might not reduce bacteria on your hands at all. For example, to kill Staph aureus, the bacteria responsible for MRSA (methicillin resistant staph aureus) infections, you must use a sanitizer with at least 62% alcohol.

• Use a hand gel with between 62% and 95% ethyl alcohol (higher than 95% alcohol might ironically be less effective).
• Rub it vigorously into your hands, including in between your fingers and along your nails, until the gel has dried.
• How much gel should you use? Enough to keep rubbing for 20 seconds without drying completely. If the alcohol evaporates in less than 15 seconds, then you’re not using enough.

You should also use it after:

• sneezing, blowing your nose, or coughing
• using shopping carts
• going to the gym
• using public computers, telephones, or ATMs
• handling a baby diaper or toys
• playing with small children or attending places such as parks and jungle gyms
• coming in contact with animals, including your own beloved Fluffy
• before seeing your next patient (this one’s for me)

Oh, and can you really set your hands on fire by using an alcohol sanitizer? This was a hoax. In reality, it would be very unlikely.

Post written by Jeffrey Benabio, MD

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Botox® blocks the release of neurotransmitters from specific nerves. When it is injected into the skin, it is taken up by the nerves, and over time blocks the release of neurotransmitters, shutting off those nerves.

In dermatology, we use botox to shut off the nerves that control muscles in your face, like your forehead and brow. With those nerves off, you cannot contract the muscles, so they stay flat. It is analogous to having wrinkles in your pants. While you are standing, the pants hang loosely and are smooth. When you sit, your thighs and hips crinkle the material, forming creases or wrinkles. In the same way, when your facial muscles contract, they bunch up, creasing the skin and forming wrinkles.

So what about the botox brain?

Results from this Italian study refute the belief that botox stays locally in the skin. They found that the botox injected into the rats followed the nerves back to the rat’s brain, shutting off nerves there.

What does this mean?

This is a critical question. The study was done in rats, not people. We do not know if it would do the same thing in humans. Even if some botox did get into the brain, there is no evidence at all that it has any meaningful effect, good or bad. For example, we know that smoking kills brain cells and stops other cells from developing. Does that mean that smokers or ex-smokers have any meaningful brain effects from their habit?

Botox is a wonderful and powerful drug. In treating wrinkles, there are few if any treatments short of invasive surgery that can compare to the results botox offers. It is, however, a drug and has side effects and has the potential to be misused and even abused. Botox has been used safely in millions of people, but there are risks. It is also expensive and its effects are temporary, so botox is not for everyone.

If you’re not comfortable with assuming risks of botox, or your budget doesn’t allow for it, then consider this effective alternative: Use a night cream that contains tretinoin (prescription Renova, Retin-A, Tazorac) or retinol (over the counter, ROC). No facial cream is more effective at reducing fine lines than tretinoin.

If you recently had botox and look in the mirror one morning and think that you’re ten years younger, don’t worry, it’s not brain damage, it’s just your face on botox.

Post written by Jeffrey Benabio, MD

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Photo credit: Gaetan Lee, Flickr.com

Data from a study at the University of California Los Angeles suggest that lip gloss increases the risk of skin cancer in women.

Ordinarily some sunlight is reflected off the skin on the lips, so it doesn’t penetrate. Shiny balms and glosses actually allow more of the light to penetrate, potentially causing damage.

Ultraviolet light damage can lead to pre-skin cancer growths such as actinic chelitis (rough scaly lips that never heal), dark spots called solar lentigos, or blebs of dilated blood vessels which form an unattractive purple bump called venus lakes. Ultraviolet light can also lead to a potentially dangerous type of skin cancer called squamous cell carcinoma.

Fear not though, glossy-lip girls, there is a simple solution.

Lipsticks and lip balms with sunscreens can protect your lips, even with the lip gloss. Apply a lip balm with SPF of 15 (or preferably SPF of 30 if you are going to be in the sun for more than 30 minutes) before you apply your lip gloss. Some of my patients have liked Kiels SPF 15 lip balm or Eco Lips SPF 30. Then leave the house both looking good and feeling good, knowing that you are protected.

Post written by Jeffrey Benabio, MD

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Photo credit: Mary B. Flickr.com