How do you clip your baby’s nails?

How do you clip your baby’s nails?

Carefully.

Worried moms often fear clipping their little ones’ little fingers.  This is not uncommon as the infants don’t respond to directives to stay still.  This issue of nail clipping an important one for me as I learned to clip the nails of my eczema baby’s nails to prevent his nails from ripping up his skin.  Those nails needed to be short!  (This brings back memories from my violin teacher.)

So what are some ways to make keeping your baby’s nails short easier?

  • Use a nail clipper designed for babies.  No, do not use your adult-sized nail clippers.  They are too large and the blades may be too thick.
  • If you’re struggling to see your baby’s nails, look for a clipper with a little magnifying glass.
  • Try baby nail trimming scissors.  Those with the rounded tips may be best if you worry about poking your baby with sharp scissor tips.
  • Try this Zoli electric baby nail trimmer.  It has little “sandpaper” like pads that buff the excess nail away.  Each pad is meant for a different age range.  Just be careful, held next to skin, these pads can also buff away skin!
  • Try a good ol’ fashioned emery board.  This may be slow going though and it may be hard for your baby to keep still as long as you need to do an adequate job.

What other tips do you have?

Join an NIH study if you suffer from urticaria from water, sun, pressure, vibration or exercise

Several readers contacted me after a previous posting about jogging causing itching.  The below NIH study may be of interest from people who suffer from this condition and also other urticarias.

A team at NIH led by Dr. Hirsh Komarow is studying physical urticarias caused by water, sun, pressure or vibration (such as caused by exercise or exposure to vibrating tools, etc).  Dr. Komarow is recruiting patients for this study and particularly interested in patients with other family members who are affected as well as severe cases.  The link to the study is available on the clinical trial.gov site here .  If you are interested or are looking for more information, contact: komarowh@mail.nih.gov or (301) 594-2197.

I’m looking forward to seeing the results of this study.

Do you have a new or changing growth? Don’t wait to get it checked out!

Pigmented Lesion - MelanomaToo frequently, I meet new patients who come in noting they’ve had a skin growth they’ve been concerned about for months, a year, or even years.  Some have had growths that have continued to grow in size, bleed, break open and even take over the face — growing into the eye, ear, or lip.  Not surprisingly, these were skin cancer.

Why this wait before seeking care?

Is it because it takes so long to get in to see doctor?  Certainly, access to a physician, and specifically a dermatologist, can be difficult and healthcare systems need to work on this problem, but wait times will rarely be over a year!  Many practices also triage their calls to get patients who may have skin cancers in earlier.

In several of my interactions, people have been reluctant and even scared to seek care.  Reasons I’ve heard include: 1) the growth wasn’t bothering them that much, 2) they didn’t think it would be anything serious, and 3) they were scared about what would happen if they did have a skin cancer.

Interestingly, I think back to why people do seek care for a new or changing growth.  Oftentimes, it is a spot that the patient has picked up him/herself, but often, it’s someone else — most commonly a spouse — who has encouraged the patient to seek care.  I’ve also had a handful of patients whose hairdressers kept pressing the patient to seek care.  And guess what?  Turned out that they did have skin cancer.

Have you waited before seeking care for a new or changing growth?  If so, why? 

Is there enough awareness about getting skin checks from your doctor, doing your own self skin checks, or when to seek care?

If you do have a new or changing growth on your skin, don’t wait.  Pick up the phone and call a/your dermatologist or your primary physician to get it checked out.  Explain your concerns about having skin cancer.  When skin cancers are caught early, they can be very curable.  However, there are many types of skin cancers, and some unfortunately are aggressive and not easy to cure once they have progressed or traveled to other parts of the body.

New Year’s Skin Care Resolutions for 2014

Hello 2014!

Up here in the Northeast, we’ve been greeted with 2 feet of snow to ring in the new year.  With travel restrictions in effect, it’s the perfect time to roll out our top 10 skin care resolutions for 2014!

#10. Wear sunglasses when you’re out in the sun.  Sunglasses with the proper UV protection will protect your eyes from damaging UV rays and also help prevent wrinkles and brown spots from forming.  Also, they will allow you to not squint as much — which can also lead to crow’s feet wrinkles too!

Image from wikipedia user Serenity.
#9. Frequent handwashing can lead to dryness and a rash.  Wear gloves when doing household chorse. Image from wikipedia user Serenity.

#9. Wear gloves when doing household chores.  For those of us bearing the brunt of chores like washing the dishes, doing laundry, dusting, polishing, etc, gloves can be a game changer in preventing exposure to irritants and excess water.  Gloves don’t have to be expensive — those thin disposable plastic food handlers’ gloves come in handy.

#8. Moisturize!  After you step out of the shower, pat dry and remember to moisturize.  How do you moisturize? How do you choose a moisturizer?  Check out our 2013 post answering these questions here.

#7. Get enough sleep.  Easier said than done but make a schedule for yourself (and your kids) and try to stick to it.  Our bodies’ repair mechanisms work hard as we’re asleep.  Our body is a machine that needs to repair itself from wear and tear.  This includes wear and tear to the skin.

Choose a fragrance-free hypo-allergeneic moisturizing cream or ointment.
#8. Keep your skin moisturized and thus smoother and more comfortable.

#6. Make sure to keep hydrated.  This means drinking enough water each day so that you don’t end up with cotton mouth (and smelly breath) and chapped lips.  This will help maintain your skin turgor to keep your skin looking healthy.  This will help a lot against the blustery winds and dry air in the wintertime.

#5. Get your moles checked.  Your primary care physician or dermatologist should check your skin for skin cancer.

#4. Do monthly self-skin examinations.  The Skin Cancer Foundation has step-by-step instructions along with what to look for here.  If you are a woman, you can do these self-skin exams at the time of your monthly self-breast exam.

#3. Remove your makeup before going to bed.  So you got ready before your night out, putting on makeup on your eyes, face, etc.  After your night out, you may just want to hit the sack.  Before you do so, make sure to remove your makeup – especially that eye makeup!  Leaving on your makeup can clog your pores, and irritate your skin and eyes.  Feeling lazy? Find handy makeup remover wipes like these from Neutrogena or Almay.  Or go for a convenient wipe off cleanser like this one from Shiseido.

#2. Wear your sunscreen.  Ultraviolet (UV) radiation from the sun leads to skin cancers and old, wrinkly skin.  In 2013, researchers in Australia showed that sunscreen keeps your skin looking young!  We recommend daily SPF30 or greater.  Make sure you know how to use sunscreen properly.  Many people do not apply sunscreen frequently enough or do not apply enough (one shotglass full for the entire body).  Also, make sure your sunscreen covers UVA and UVB.

#1. Stop smoking.  Work with your primary care physician to get extra help in quitting tobacco.
#1. Stop smoking. Work with your primary care physician to get extra help in quitting tobacco.

#1. Are you a smoker?  Don’t forget the 2013 photos from the Journal of the American Society of Plastic Surgeons showing the photographs of twins where one was a smoker and the other a non-smoker.  Let the photos speak for themselves.  Save your skin (and your health)! Look younger! Don’t smoke!

What is a board-certified dermatologist?

You may have noticed the term “board-certified dermatologist” on various dermatology clinic and hospital websites.  What does board-certified mean?

The American Board of Dermatology certifies a certain number of new dermatologists each year.  In addition, it requires dermatologists to keep up with various steps to maintain certification throughout the dermatologist’s career.  This helps to maintain the quality of dermatologists to properly serve patients and the public.

Board-certified dermatologists have passed the American Board Exam in Dermatology, a rigorous full day examination held once each year (and currently taking place this week and next in Tampa, Florida).  They have also completed medical school, a year of training in medicine or surgery, and at least 3 years of an accredited dermatology residency program.  They have met the requirements to receive a full license to practice medicine in their state.  Additionally, there are several other requirements.  As one proceed’s in one’s career, there are other requirements to continue assessments of knowledge and competency, continuing education, quality improvement in one’s practice, etc.

Whereas anyone who is a doctor seeing skin could theoretically decide to call her/himself a dermatologist, a board-certified dermatologist must complete all of the rigorous steps above, ensuring a higher level of quality.

What is Neurofibromatosis?

Neurofibromas in neurofibromatosis often appear during puberty or adulthood.
Neurofibromas in neurofibromatosis often appear during puberty or adulthood.

In dermatology, we have many conditions that are caused by defects in a specific gene. In the case of Neurofibromatosis 1 (we’ll go over other Neurofibromatoses later), the defect is in Neurofibromin.  The transmission is autosomal dominant, meaning that to have the condition, you only need one of the mutated genes to be passed on from either mom or dad.

Neurofibromatosis 1 (aka Von Recklinghausen disease) is a syndrome, meaning, several different findings are seen.

These include:

cafe au lait macules which are flat tan spots of the skin and show up either at birth or early in childhood. The number and size of these spots can increase with time. The criteria for diagnosis includes having 6 or more of these spots and sets 5 mm as the minimum size in a kid, or 15 mm in those who are past puberty.

– clumps of pigment causing growths in the eyes called Lisch nodules or iris hamartomas which usually show up during childhood.

– freckling of the armpits – aka axillary freckling or Crowe’s sign. This shows up in later childhood.  Freckling can also occur in the groin area (inguinal freckling).

– soft fleshy growths on the body called neurofibromas which show up during puberty or adulthood.

– growths in the eye nerves called optic glioma(s). These growth can affect vision, potentially leading to vision loss.

– plexiform neurofibromas which are not the standard neurofibroma. These are more complex, often deeper in the skin and larger.  These have a chance of turning into a type of cancer called a malignant peripheral nerve sheath tumor.

– bone abnormalities including the bones around the eye and of the bones of the extremities..

There are other findings which may be seen as well, such as high blood pressure.

What are genital warts?

Genital warts are growths that occur on the genitals  and anus.  They may appear skin colored, pinkish, tan, or brown and are often raised and soft.  In the medical field, we often refer to them as condyloma or condyloma acuminata.  These condyloma (although colloquially referred to as genital warts), can occur on other areas as well (e.g. around the mouth/lips, inside the mouth, throat, etc.)

What causes genital warts? Genital warts are caused by the human papilloma virus (HPV).  HPV types 6 and 11 cause the vast majority of genital warts.

How do you get genital warts?  Genital warts are considered a sexually transmitted disease.  The virus is spread through close contact with an infected individual.

If you have genital warts, can you spread them to someone else? Yes, as above, the virus is spread via skin to skin contact.  Thus, you can continue to spread it to sexual partners.  Although barrier protection is not perfect, it can decrease the likelihood of transmission.

If you have genital warts, does that mean you will have cancer?  Recently, there has been a lot of buzz about HPV and cancer.  The media reported that Michael Douglas said his throat cancer was caused by the HPV virus.  There’s some controversy over what was said exactly, but recall that he talked about how oral sex could lead to transmission of HPV virus.

Anyways, just because you have genital warts does NOT mean you will get cancer.  HPV 6 and 11 which we said is linked to the majority of genital warts is less linked to  cancer.

How do you treat genital warts? There are several types of different treatments.  Cryotherapy involves freezing the wart, often with liquid nitrogen.  The lesions may also be burned or treated with a laser. Sometimes they may be cut off with a scalpel or scissors and other times they may be treated with a liquid or cream.  Injections have also been used for genital warts.  Find a physician who has experience treating genital warts.

 

‘Tis the Dermatology Interview Season, cont.

The Dermatology Interview Season is firmly underway! 

This can be a very exciting but also stressful time.

Here are some of my personal quicktips for the interview season based on past experience (disclaimer, my past experience was years ago…):

Pre-interview dinners. Helpful to go.  You’ll learn a lot about the program and the personality of residents.  Some programs may ask for feedback from residents or faculty who are present.  Be yourself.  Be nice.  Try to be on time (although winter travel can always be tough to predict!) Look up the restaurant and dress appropriately.

Tips for the interview. It may be helpful to take a look at the frequently asked questions list.  Get a curveball?  Don’t worry — probably meant to see how you think through things or respond.  You’re not expected to know everything or be perfect.  And it’s okay to say, “I don’t know” — that’s true for any situation.

Thank you letters. Rank list is probably already made by the time your letter arrives, but send emails or letters as you see fit; try to put something somewhat personal in there.

‘Tis the Dermatology Residency Interview Season

Sure, it’s the Holiday Season, but it’s also residency interview season! Some of you may be in the midst of interviews (granted, you’re probably catching a well needed break this week and neck).

Here’s a list of some FAQs that would be handy to be prepared for at your dermatology residency interview!

Why derm?
Why this program?
Why this city?
What are you looking for in a program?
What other programs are you considering?
If not derm, what would you do?
Tell me about yourself.
Tell me about a difficult situation you have been in.
Tell me about a medical case where an ethical problem came up.
Tell me about an interesting derm case.
What is the most interesting thing you have done?
Tell me about your research/project/case report.
Who are your role models?
Tell me about the last book you read.
Specific interests in derm?
Where do you see yourself in 5 years? 10 years?
When have you been a leader?
How are you a team player?
What achievement are you most proud of?
Any questions?

For research applicants:
Be prepared to give a 5 min synopsis of your research.
Be prepared to answer ?’s regarding literature surrounding your area of research.
Who are potential research mentors at this program?
If you don’t have a PhD, do you think you can be a successful physician-scientist?
What challenges do you envision as a physician-scientist?
Why do so few dermatologists do research or stay in academics and what makes you different?