How to Apply Tretinoin (Trust Us . . . It Matters)

What is the number one issue with tretinoin? It takes weeks for your skin to adjust. That adjustment phase can include redness, dryness, flakiness, and skin sensitivity. Like any new routine, it’s easy to give up too soon or get frustrated because you aren’t seeing results overnight. Or to be too ambitious and apply it too generously and irritate your skin.

So knowing this, what is the best way to introduce tretinoin into your skincare routine? The short answer is . . . gradually.

The first key with starting to integrate tretinoin is to know when to apply it. Tretinoin should be applied to the entire face nightly — AFTER washing your face and in combination with a moisturizer.

When you first start tretinoin, your goal is to apply a pea-sized amount to your entire face 2-3 nights a week. (And while you’re at it, don’t forget to apply a small amount to your neck and back of your hands too.) Once you’ve been able to tolerate it consistently 2-3 nights a weekly, gradually increase your frequency by one night a week until you can manage a nightly application. Never reach the point where you an tolerate nightly usage? It’s okay! Your skin will still benefit even from 3 nights a week of use!

The next most important tip is to use a moisturizer with your application. There are many ways to do this — you can apply your moisturizer before tretinoin; after tretinoin; before AND after tretinoin (the “sandwich method”); or you can mix the tretinoin into your moisturizer. Experiment and see what works best for you. Don’t have a moisturizer you love? Three inexpensive moisturizers that our physicians love are Vanicream Daily Facial Lotion with Hyaluronic Acid, Neutrogena Hydroboost Gel, and The Ordinary Hyaluronic Acid Serum. All three of these are affordable, non-comedogenic,and blend well with tretinoin.

Still having trouble? You may want to talk to your dermatologist about adjusting your tretinoin prescription — it comes in many concentrations and you may need to adjust to a gentler strength. Or you may need to try the micro-encapsulated form (Retin-A microgel or tretinoin microspheres), which is generally less irritating.

As always, we are here for you. If you need help or have questions about your specific skincare needs, schedule an in-person or telehealth appointment and we’d be happy to walk through this process step-by-step with you!

Tretinoin -- All your questions answered!

Tretinoin— it’s all over social media. What’s the scoop? Dermatologists have been prescribing and recommending tretinoin for years, and the secret’s out — tretinoin is your number one choice (after sunscreen, of course) for preventing premature aging and fighting back against dark spots, discoloration, fine lines, wrinkles, and large pore size.

So what is tretinoin? Tretinoin is a vitamin A derivative that is available in the U.S. as a prescription cream. When applied to the skin nightly, it has myriad benefits. Tretinoin historically has been prescribed primarily for acne because it unplugs the pores (bye bye, pesky blackheads!), which addresses acne at its root cause. Over time, tretinoin can reduce the appearance of pores by keeping the pores clear and unclogged.

Tretinoin also increases cell turnover (hello, exfoliation!) which in turn brings unwanted pigment up and out of the skin. This also results in softer, smoother skin that is less dull in appearance. But the biggest benefit of all is that tretinoin actually BUILDS collagen. Collagen is the support protein in the skin and as we age, we gradually lose collagen — which results in the formation of fine lines and wrinkles. But regular tretinoin usage actually boosts collagen production, which results in a more graceful, gradual aging process in the skin.

If you’re interested in tretinoin, please bring it up at your next office visit! All of our board-certified physicians and ourPA are well-versed in the types/strengths of tretinoin and can help pick the best version of tretinoin for you. Never been seen at our office? We’d be delighted to help you — our new PA, Britney Hayslip is accepting new patients and can get you started on a new, simple, effective skincare regimen before the New Year!

Spring Allergy Season -- it's Here

You’ve probably noticed — the daffodils are blooming, flowering trees are blooming — and now your nose is also itching. This winter was milder than usual, and as a result, the spring trees are blooming a few weeks earlier than normal. Spring allergy season is officially underway.

So far, this appears to be a somewhat warm, early spring. The combination of an early tree bloom with subsequent pollen release, as well as the increased moisture from rain and storms — which stirs up mold — means allergy sufferers may be in for a difficult season these next few months.

If you usually have a bad spring with allergies or sinus issues, we can help. Getting allergy tested to determine your triggers, and starting an appropriate treatment plan (which may include medications chosen based on your triggers, avoidance measures, and for highly allergic patients, desensitization with allergy shots) can make all the difference. The goal is for our patient, when asked how their spring allergy season is going, is to be able to say, "No big deal!"

Acne -- in the Winter?

Skin care, like many things, is seasonal. Typically we think of winter as being the season for dry skin and summer the season for oily skin; which means when you have acne, summer is typically the season when you experience break-outs.

But some patients with acne experience flares in the winter — what is that about? Let’s talk about an uncommonly discussed version of acne called acne cosmetica. Basically, this is acne that is triggered by overuse of skincare and cosmetic products — in this case specifically, overuse of moisturizers to combat excessively dry skin.

When our skin gets naturally drier in the winter, the most common response is to use moisturizer. Makes sense, right? The skin is dry, so we increase product usage to manage the dryness. When you have acne-prone skin, however, this can create a secondary issue — clogged pores, leading to pimples.

So what should you do if you have acne and your skin is really dry during the winter? Here are a few tips to try.

1. Try to minimize dryness by cutting back or eliminating any unnecessary skin care products that dry out the skin. You may find that you only need to wash your face at night and can get away with skipping your cleanser in the morning. You should strongly consider avoiding toners and any other products that strip your skin of its natural oils. These products may be a lifesaver for you in the summer — but consider skipping them in the winter.

2. Reduce the frequency of your tretinoin/retin-a/retinoid usage. You may want to cut back to using these products to 3 nights a week during the winter, since they are naturally drying. By reducing dryness from retinoid usage you may not need as many thick emollients to combat dryness.

3. Make sure any moisturizer you use is non-comedogenic. Two inexpensive drug-store favorites that we recommend every day are Vanicream Daily Facial Lotion with Hyaluronic Acid and Neutrogena Hydroboost Gel.

4. Consider running a humidifer in your bedroom at night to keep the humidity up overnight.

5. Use a gentle exofoliant to help remove dry skin and flakes, rather than a drying face mask. Dr. Amy Valet really likes the Real Chemistry 3 Minute Peel twice a week to remove dead skin cells.

We hope these tips and tricks help you if you are experiencing an acne breakout this winter that is due to overuse of moisturizers and skin care products! And as always, if you need an appointment, just give us a call! Telehealth appointments are also an option for our acne patients!

Sunscreen -- friend or foe?

With the news last week in national media that there is evidence that ingredients in sunscreen can be absorbed through our skin into our bodies — what does that mean as we approach summer? Should we still be wearing sunscreen?

According to our physicians, the answer is YES! You should still wear sunscreen!

Here’s why we still feel that sunscreen is useful. Absorption of sunscreen ingredients in miniscule quantities does not imply harm. While we are going to be paying close attention to this new area of research, at this point there is no evidence to support that sunscreen usage increases risk of internal organ cancers, and there is also no evidence to support that sunscreen usage causes endocrine disruption.

That being said, sunscreen has always been best used as a last line of defense from the sun. The rules for sun protection still hold true and right now is a timely moment to review those.

1. Avoid mid-day sun — Dermatologists ALWAYS recommend that you avoid being outdoors in diret sunlight during the middle of the day. This is when the sun’s rays are the most harmful and no amount of sunscreen is going to overcome the amount of sun damage that will occur with just 1-2 hours of exposure during this time window. At the beach? Go inside between 11 and 2 — eat lunch, take a nap, watch TV, or read a book — and save your skin at the same time.

2. Seek Shade — When you need or have to be outdoors, seek shade whenever possible. If your kids play baseball and you have a game on Saturday at noon, obviously you aren’t going to stay home. But try to sit in the shade — bring an umbrella, set up your chair under a tree, etc.

3. Wear Sun Protective Clothing — This is so important. UPF swimwear and sportswear will do a much better job of protecting your skin from the sun than sunscreen ever will. Invest in a few rash guards and spf sports wear shirts and perhaps pants and your skin will thank you later. This advice also means wear a hat and sunglasses whenever you can!

4. Wear spf 30+ to Exposed Skin — When you have to be outdoors, and you can’t sit in the shade, put on your sunscreen! Anything spf 30 or higher — if you have a history of melanoma and are going to be at the beach, you need to be wearing a higher spf — we recommend 85.

So you can see, if you are following the above rules for sun protection, your sunscreen usage is actually going to be greatly minimized. Not only will your skin be better protected, but you will also save yourself unnecessary chemical exposure.

The last point we would like to make is that UV light is certainly CARCINOGENIC. Unfortunately we diagnose many, many new cases of skin cancer each week including malignant melanoma. While the research is still being done on the safest and most effective sunscreen ingredients, dermatologists are always going to recommend sunscreen as one of your effective options in protecting your skin from the sun and minimizing your risk of skin cancer.

Too Close for Comfort

Has too much time on the couch with furry members of the family been hard on your nose and sinuses this winter?

The cold winter weather tends to keep us all huddled together in our homes. But for allergy sufferers, close quarters with pets, dust mites, and other indoor allergens can make winter a tough time for allergies and sinus infections.

Indoor allergies represent some of the most common sensitizations, particularly to dust mite and pet dander. Dust mites are microscopic insects that eat the skin cells that we shed, and so they multiply the most in our bedding, couches, and other places where we spend a lot of time. Reducing dust buildup and keeping humidity low (dust mites get their water from the air) help, but dust mites are nearly impossible to completely avoid.

Dander from furred pets is another very common allergy. Keeping pets out of bedrooms (ideally outside!), bathing/grooming regularly, and cleaning regularly to reduce dander buildup can be helpful.

If you have hard winters, with recurring nasal/sinus symptoms, it may be worth completing allergy testing to see if pets or dust (or other indoor allergens, like mold, cockroach, rodents, and others) are driving your symptoms. Treatment options can include avoidance measures based on your allergy triggers, medications, and in some cases allergy shots to desensitize patients to particular triggers such as their pets.

If you’ve noticed that all the winter togetherness has been bad for your allergies, we can help you feel your best while spending time with all the members of your family, even the furry ones.

Hair Loss and PRP Injections

I see many patients in the office for evaluation of hair loss. Hair loss is complicated and for most patients, it is also emotionally upsetting. What can we offer our patients who are suffering from hair loss?

The first step is an examination of the scalp and hairs and a thorough medical history. When I am examining someone’s scalp and hair, I am asking myself several questions — first, I am looking to see if there is evidence of scar tissue. Ideally when I examine someone’s scalp I hope to not see scar tissue, as that tells me that the process may not be permanent. Next, I examine the scalp to see if there is evidence of a rash or inflammation or infection — this might look like redness, scaling, bumps, or dandruff. Finally, I may consider ordering labs if a patient’s primary care physician hasn’t already, to evaluate for an underlying medical disorder — it is important to rule-out anemia, thyroid disorders, and other metabolic abnormalities.

After the first examination, it may be apparent immediately what the cause of the hair loss is and the diagnosis can be made, along with a discussion of treatment options.

If the diagnosis is not immediately obvious, I will often recommend to the patient that he or she undergo a scalp biopsy. This is a small, minimally invasive procedure where a small portion of the scalp is numbed and a small piece of tissue is taken for microscopic examination. This procedure is not painful (other than the first stick of the needle for numbing!) and yields valuable information that often leads to the correct diagnosis.

Once the diagnosis is established, my patients and I can have a discussion about treatment options and what to expect. Lately, my favorite type of hair loss to diagnose is androgenic alopecia — or male- or female-pattern hair loss. Thankfully this is also the most common cause of hair loss.

Androgenic alopecia is mediated by hormones. All men and women have testosterone circulating in their bodies as part of their normal hormonal make-up. Unfortunately, some people have hair follicles that are extremely sensitive to their body’s normal levels of testosterone and what this results in is “miniaturization” of the hair follicles (which can be seen under the microscope with a biopsy). What miniaturization means is that the hair follicle (the organ that grows the hair shaft) is still present in the skin, but it is simply shrunk down to miniature size and is no longer growing a nice, healthy hair.

The good news about hair follicle miniaturization is that it is potentially reversible! Treatments include Rogaine 5% solution to the scalp, prescription medications such as finasteride (for men) and spironolactone (for women) to block the hormones at the level of the hair follicles, and PRP (platelet-rich plasma) injections into the scalp.

PRP injections are the latest trend in treating hormone-mediated hair loss and the good news, if started early in the disease course (within the first few years), it often works and works extremely well! We draw your blood at your procedure appointment and spin it down in a centrifuge, then extract the platelet-rich plasma and inject it back into your scalp. PRP contains your body’s own growth factors to stimulate those resting miniaturized hair follicles to get back into growth phase and start growing hairs again! PRP injections are performed monthly x4 months, and then twice annually for maintenance.

If you are interested in scheduling a consultation to evaluate your hair loss, call us today at 615-212-3012! We’d be happy to help you out.

Top 5 Reasons to See a Dermatologist

It's September 5 -- Labor Day has come and gone, the kids are back in school, and all the parents are sighing a collective sigh of relief! Back to routine!

This is a time of year when many parents are able to find a few extra hours in the week to catch up with dental appointments, doctor's visits, hair appointments, etc. We have been seeing an increase in appointment requests for these top 5 skin issues:

1. Skin Cancer

Have a changing mole or new lump or bump on your skin? Skin cancer affects 1 in 4 Americans over their lifetime. Here at Traceside we have had many new diagnoses of basal cells, squamous cells, and unfortunately melanomas over the past few months. If you are concerned you damaged your skin over the summer or have a new lump or bump that won't go away, please call and let us take a look.

2. Sun Damage

Summer is over and many of us are now seeing in the mirror the after-effects of too much sun. Brown spots, uneven skin texture, new lines and wrinkles are all issues that we can help address -- usually with a combination of recommending a personalized skin care regimen, plus possibly chemical peels, botox, fillers, and other cosmetic procedures.

3. Rashes

Sometimes an unintentional consequence of trying to revamp your skincare at home (without the help of a professional!) produces skin irritation, redness, itching, and other problems. We see a lot of patients who have developed an allergy to their skin or hair care products. If you are dealing with a rash on your face, eyelids, neck, or hands that just won't go away, we are here to help. Through a combination of medical treatments and testing, we can help fix this problem!

4. Cysts

Dr. Pimple Popper has put cysts on the radar of many Americans. And yes, cysts for some reason seem to flare during the warm weather months. Dr. Valet has removed many cysts this summer. If you have a bump or lesion under your skin that is swelling and bothering you, we can help.

5. Acne and Rosacea

The heat, sweat, and sunlight that is a natural part of a Southern summer can contribute to acne and rosacea flares in the summer and early fall. We can help clear up these common skin issues with a combination of skincare advice and prescription medications. Don't continue to suffer with acne and rosacea unnecessarily when help is available!

Allergy Season Arrives--Story at 10!

With the arrival of March, spring allergy season is officially underway. You have likely noticed the first of the trees starting to green up; maple, red cedar, and a few others are typically the first to start blooming, sometimes as early as the end of February in Nashville.

Every year allergists are asked how this season compares to prior years. I have done many local news interviews over the years, that typically go something like this:

News anchor: "How bad is the pollen season this year?" (looking at me hopefully)

Me: "It's bad!"

News anchor: (nodding) "Back to you Jim."

The better answer is, it depends (the local news doesn't really like to lead with "it depends--story at 10"). So far, this appears to be a somewhat warm, early spring. Whether that means the trees will flower and continue to flower vigorously because of warm weather, or whether a late cold snap might kill off their early growth and lead to a light tree pollen season because they started growing too early, remains to be seen. Also, all the rain we've had tends to lower pollen counts by removing pollen grains from the air, but conversely, a good moist spring may favor vigorous tree, grass, and weed growth. Additionally, for other patients who are mold allergic, all the moisture will favor mold activity, and hard rains can stir mold and other allergens from the ground into the air (so called "thunderstorm asthma," named for the phenomenon of allergic asthmatic patients reacting following storms). Finally, the spring weather itself (e.g. changing temperature and moisture levels) can act as an irritant trigger, causing nasal symptoms in many patients.

As all of this suggests, at the end of the day, what matters is what you are allergic to, and whether it ends up in your nose. If you usually have a bad spring with allergies or sinus issues, we can help. Getting allergy tested to determine your triggers, and starting an appropriate treatment plan (which may include medications chosen based on your triggers, avoidance measures, and for highly allergic patients, desensitization with allergy shots) can make all the difference. The local news may not like it, but the goal is for anyone asked how their spring allergy season is going to be able to say, "No big deal!"

Is it a Cold . . . or Allergies?

In this article published on StyleBlueprint, Dr. Robert Valet discusses how you can tell the difference between a viral cold and allergies. Interested? Read more by following this link:

https://styleblueprint.com/nashville/everyday/allergies-or-cold/

Happy Valentine's Day, Spring Allergy Sufferers!

Valentine’s Day…when a young man’s fancy turns to…nose sprays. At least, it should, if he has springtime allergies!

The spring allergy season in Nashville begins in earnest in March, when trees begin pollinating. Because of the very large amount of pollen produced during a short time window (trees typically are done producing pollen for the year in April), early spring is a highly symptomatic time for many allergy sufferers.

If your symptoms have been out of control during previous springs, if you were to pick one medicine that is most likely to be helpful, it would be a nasal steroid spray. Over the counter examples include Flonase, Nasacort, and Nasonex. Nasal steroids have consistently outperformed other types of allergy medication (for example, antihistamine pills) in a variety of studies. However, they do not work overnight and are not good for as needed use. Typically, they require 2 or more weeks of continuous usage to reach full benefit. Given that tree pollen is out by early March in our area, this means starting a nose spray by mid-February in order for it to be fully on board by the time spring allergy season begins.

If your allergies typically get out of control this time of year, we can help. Allergy testing is very helpful to determine which allergens are driving your symptoms, which guides avoidance advice and opens the option for allergy shots to retrain your immune system to tolerate your triggers. In other cases, patients with prominent springtime symptoms are not sensitized to allergens, but rather have vasomotor rhinitis, meaning that their symptoms are triggered by air quality, scents, shifting weather patterns, and other non-allergic triggers. Treatment for this is somewhat different, and again, testing is key in order to determine what are your most important triggers.

Having an enjoyable spring, without uncontrolled nose and eye symptoms or severe sinus
infections, should be an achievable goal for everyone. We would be happy to work with you to help you feel your best this time of year. In the meantime, show your nose some love this Valentine’s Day, and start that nose spray!

Addressing Sun Damage in the Winter . . . Great Summer Skin Starts Here!

Here in the middle of January, most of us are doing our best to make it through the cold months and flu season. It's cold outside, it gets dark early, and we are looking forward to spring. Because most of our time is spent indoors, many people neglect their skin care and sunscreen routines in the winter.

But did you know that the winter season is the best time to address sun damage and pigmentation changes in the skin? Don't stop your skin care routine now!! If sun damage has resulted in uneven pigmentation, melasma, sun spots, or other areas of sun damage now is the best time to start doing something about it. The lack of direct sunlight during this season makes it an ideal time to begin working on skin care.

First, start with the basics. Make sure you are wearing spf 30+ on your face, every day, rain or shine. Treating sun damage is like treating high blood pressure or high cholesterol. It will always be with you, and to keep the effects under control, daily maintenance is required. Hyperpigmentation, sun spots, and melasma can be particularly troublesome. The damage to the skin is always there, lurking beneath the surface. Sunlight will bring the damage to light by causing the pigmentation to "blossom." Keep it at bay by blocking the sun's harmful UV rays.

Second, use targeted medical-grade skin care specific to your skin's needs. The more progress you can make towards reducing the appearance of your hyperpigmentation now, the better off you will be when sunny season starts. Choosing a targeted medical grade product can be tricky and appropriate selection begins with assessing your particular needs, in addition to any underlying sensitivities or special considerations you may have. At Traceside, we have had good success treating our patients with a combination of antioxidant serums such as CE Ferulic and/or Resveratrol, prescription creams such as Finacea and Retin-a, and topical skin brighteners.

Third, if you are considering aesthetic procedures to target your skin's sun damage, tone, and texture, now is the time to start. The best results are seen after a series of treatments, which takes time. A great place to start is with chemical peels. A series of glycolic, citric, retinol, and/or TCA peels over time will exfoliate the skin, reduce hyperpigmentation, reduce the apperance of fine lines and wrinkles, and overall improve skin's tone and clarity. Because the effects are gradual, chemical peels are ideal for patients who are new to aesthetic services. The downtime is minimal with most peels and can be completed in a matter of minutes during an office visit.

Fourth, keep your  skin moisturized. The dry air so prevalent this time of year can really do a number on your skin! For combination skin, we recommend CeraVe PM; sensitive skin will do well with Vanicream Lite Lotion. Mature skin that is very dry does well with SkinCeuticals Triple Lipid Restore.

If you have questions about how to get started on achieving your best skin, call us today to schedule a cosmetic consultation. We can help!

Winterize Your Allergies with Traceside Dermatology & Allergy

In late fall, we are all busy raking leaves, tuning our heaters, and otherwise preparing our homes for winter. But wait, winterizing is not just for houses; this is a great time of year to get your allergies in good shape for winter and the coming spring!

For many people who suffer from recurring sinus infections, the winter season is tough. Respiratory viruses, dry air, and increased indoor allergen exposure make this the time when most patients' sinuses are at their worst. If this has been your experience, it is likely you have underlying chronic rhinitis. Because your nose and sinuses are partially swelled at baseline, it is harder to shrug off colds and flu without progressing into a bacterial sinus infection. At Traceside, we can help by identifying what is triggering your baseline swelling and implementing an avoidance and treatment plan to help you stay healthy and feel your best.

This isn't just time to prepare for winter; it is also a great opportunity for those with spring, summer, and fall seasonal allergies to get a jump on the season. First, since most plants have been killed by frost, many patients find this the easiest time of year to stop antihistamines for allergy testing, to identify their triggers. Secondly, to feel your best during the springtime, you will need to have a plan in place before the season starts to stay ahead of spring pollen. Finally, for patients who want to consider allergen immunotherapy (allergy shots), which in many cases permanently retrains your immune system to tolerate what you are allergic to, this is a great time to start, complete buildup, and allow maximum time for your allergies to improve, before the trees start blooming in March!

Nashville Dermatologist -- Winter Skincare Advice

Happy Halloween, everyone! We hope you all had a great time enjoying the festivities of the evening!

Since we are solidly in the middle of fall, why are we talking about winter skincare over here on our blog? Well, as the weather changes and the temperatures drop, dermatologists all over the country start to see a rash (no pun intended!) of patients coming to the office for itchy, dry skin. By making a few adjustments to your skincare, you can avoid a trip to the doctor and keep your skin symptom-free all season long.

What are the most common causes of dry, itchy skin this time of year? Typically, the causes can be reduce to one or more of the following: dry air, hot water, and harsh soaps.

The air outside during the cold weather months is very dry, causing your skin's natural moisture to evaporate more quickly. In addition, when we turn on our heaters in our homes, the air becomes even drier still. To combat this, you need to regularly apply a good, simple moisturizer. Our office favorites are Eucerin, Vanicream (great for sensitive skin!), and sometimes even just plain petrolatum!

Because we are cold this time of year, many patients take long, hot showers and baths. Nothing could be worse for your already dry skin. The heat of the water strips your skin of its natural oils, leaving it without protection when you face the dry cool air both inside and outside of your home. To minimize the drying effects of a hot shower, turn the temperature down and reduce the length of your shower. And though we hate to say it, keep the long soaking baths to a minimum. If you just HAVE to take a long soak, moisturize immediately after getting out of the tub!

Harsh soaps are another common problem. Ivory soap, though a favorite of many, is actually one of the worst soaps to use during the winter months. A true soap, it removes all of your skins natural oils. Harsh antibacterial soaps are another common offender, as are strongly scented soaps. Stick to something mild and gentle -- the Dove moisturizing bar is a great place to start, or consider Vanicream's bar soap or gentle liquid cleanser.

If you are following all of these tips, and still can't get your skin under control, it may be time to see a board-certified dermatologist to make sure something else isn't going on. If you need us, we are always happy to help! And otherwise, stay warm and enjoy the festivities of the season!

Nashville Allergist -- Fall Seasonal Allergies Explained

Are your allergy symptoms flaring up lately? If you are one of many Nashvillians with runny, stuffy nose this time of year, it is likely you are either allergic, or you aren't! Or maybe both of those! What?

We evaluate many patients with nasal symptoms that flare significantly this time of year. Until we get several good frosts, all of the plants that have been producing pollen since late spring are still active. These include grasses (northern turf grasses like Kentucky bluegrass and fescue, and southern grasses like Bermuda, bahia, and johnson) and weeds, including plantains (see earlier post for pictures!), lamb's quarter, pigweed, kochia, and many others.

However, a spike in nasal/sinus symptoms in fall, when related to pollen allergy, is usually due to ragweed. Ragweeds (Ambrosia genus) are highly allergenic plants native to the Americas. They are among the most common plants to be allergic to (depending on the study, among those with allergic rhinitis, up to 80% may be sensitized to ragweed), and also contribute significantly to asthma symptoms. In our area, we have abundant short ragweed and giant ragweed. Ragweeds are short day plants, meaning that they wait for the days to shorten again before they start to flower, and so they begin flowering in much of the US beginning around the middle of August. If you have fall allergies ragweed may well be an important allergen for you. We can complete skin testing and get you an answer in about a half hour. If you are allergic, this opens additional options including allergy shots and ragweed sublingual immunotherapy (for which there is a FDA approved product, Ragwitek).

Many patients who flare this time of year have negative skin testing to common aeroallergens, known as vasomotor or non-allergic rhinitis. These patients have much the same nasal/sinus symptoms, but are reacting to the changing weather and air quality patterns that occur rapidly in the fall, rather than to pollen in the air. This is another situation where skin testing is very helpful, because it can tell you that you may be able to stop medicines, including Singulair and oral antihistamines, that are unlikely to benefit you if you don't have allergic triggers for your nasal symptoms.

Finally, some patients have allergy by skin testing, but clearly also have non-allergic triggers (for example their fall flare isn't explained by what they are allergic to, or by history they also react around non-allergic triggers like perfumes/strong scents). These "mixed rhinitis" patients can benefit greatly from a combination of therapies targeting both allergic and non-allergic triggers.

If you aren't feeling well this fall, let us review your history and find our what is driving your symptoms, to help get you on the right treatments to feel your best!

Nashville Dermatologist -- Should I get this checked? A guide to skin cancer awareness

One of the most common questions we get asked is, "How do I know if my mole is cancerous?"

Here in the Southeastern United States, we are all exposed to the damaging effects of UV rays Every. Single. Day. Rain or shine, winter or summer, the sun is always out and most of us experience the damaging effects of UV radiation. And we know for a fact that 1 in 5 Americans will be diagnosed with skin cancer in their lifetime.

So, what are the warning signs that you may be developing a skin cancer?

The pnemonic "ABCDE" is helpful in evaluating whether that new mole is worrisome or not. If your mole meets one or more of the following criteria, you ought to have your mole checked:

A = asymmetry -- when the two sides of your mole don't match

B = border -- if the border or edge of your mole is irregular

C = color -- if the mole is multiple colors or changing colors

D = diameter -- if the mole is growing in size or is larger than 6mm (the size of a pencil eraser)

E = evolution -- if the mole is changing

And in general, we find it most helpful to evaluate by the "new or changing" criteria - which means if you have a mole that is new or changing, you ought to have it looked at -- particularly if it has irregularities in color, shape, or border or has become symptomatic such as itching or bleeding.

And don't be fooled if the mole isn't brown! Although melanoma often has pigment with it, it can be pink and other skin cancers such as basal cell carcinoma and squamous cell carcinoma are often pink.

When in doubt, get it checked!

Nashville Dermatologist -- Skin Care 101 -- a regimen for prevention

So we have defined that there are a lot of great skin care products out there and discussed how it is important to choose products that are designed for you and your skin type. Because if you have acne-prone skin but use a product that is heavy and intended for very dry skin, you might make your acne worse! It is so important to be very picky when it comes to choosing products -- one size DOES NOT fit all in the skincare world!

Today, we are going to talk about a very common skin type that I see in the office all the time. The 30-something female patient with mild sun damage and combination skin who wants to start a good regimen to preserve her skin and prevent additional damage.

Here is what I typically recommend:

In the morning

 This patient needs a good gentle cleanser. Products to consider are the SkinCeuticals LHA Cleansing Gel (which we carry), or OTC Cetaphil Gentle Skin Cleanser.

After her moisturizer, she needs a good sunscreen that is designed for use on the face. If her skin tends towards blemishes, I always recommend Elta MD UV Clear. If her skin tends towards dryness, I recommend Elta MD UV Daily. At the drugstore, a good brand is Aveeno.

Next, I recommend a Vitamin C serum. My favorite for this age-group is SkinCeuticals Phloretin CF. It is applied every other day in the morning and works to provide additional protection against environmental damage and also helps to repair past damage.

After that, this patient should apply her favorite makeup and her morning skincare routine is done!

In the evening

It is critical to remove makeup at night and use a cleansing regimen that also exfoliates. Here I recommend using the same morning cleanser (SkinCeuticals LHA cleansing gel or Cetaphil Gentle Skin Cleanser) with a Clarisonic face brush. Clarisonics are amazing. They gently exfoliate, which allows your skin to absorb any products that you use and also clarify the complexion, leaving the skin less dull. I use mine every night.

After cleansing, apply a topical retinoid. I usually recommend patients start with OTC Differin 0.1% gel if the skin tends to be sensitive. If the patient has been using a retinoid for awhile, she can probably tolerate tretinoin 0.05% cream (retin-a). If the patient is pregnant or trying to become pregnant, prescription Finacea gel or foam is the best. Use these products every other night to start, and gradually increase to nightly usage.

If the skin tends to be dry, I recommend an light moisturizer after the retinoid -- at the drugstore, a great moisturizer is Vanicream Lite Lotion.

This is a simple skin care regimen that provides all the protection an average 30- year-old female with combination skin needs to exfoliate, protect, and restore!

Nashville Dermatologist -- Skin Care 101, Part Two

In June, we talked about how important it is to understand your skin and what problems you are trying to correct when you go about picking a skincare regimen. Today, let's go into greater detail about common types of skincare products so that you can better understand what is available to you today.

In the world of skincare, there are many different categories of products. Here are the major categories (clearly, this is why this can be so confusing!):

1. Cleansers
2. Toners
3. Exfoliators
4. Sunscreens
5. Antioxidants
6. Moisturizers
7. Acne Products
8. Rosacea Products
9. Hyperpigmentation Products
10. Anti-Aging Products
11. Skin Soothers
12. Eye Creams
13. Neck Creams

What of the above do you need? Why would you choose one type of product over another? Let's start with the top and work our way down.

1. Cleansers -- designed to remove excess oil, dirt, and make-up off at the end of the day; everyone needs one of these!

2. Toners -- an alcohol-based solution designed for acne patients to remove excess oil; we generally do not recommend using a toner; unless your skin is excessively oily, this is just going to dry and irritate your skin

3. Exfoliators -- mild acid-based solutions, scrubs, or mechanical devices designed to remove excess skin; this is a must, but the choice of which product depends on your skin type

4. Sunscreens -- designed to protect your skin from the sun; another MUST! 

5. Antioxidant -- designed to be used in addition to sunscreen to protect from UV and environmental agents that age your skin; another MUST!

6. Moisturizer -- designed to combat skin dryness

7. Acne Products -- over-the-counter versions include salicylic acid and benzoyl peroxide; many presription products are available; all designed to help treat, control, and reverse acne

8. Rosacea products -- both over-the-counter and prescription products used to correct and reverse the various aspects of rosacea

9. Hyperpigmentation products -- OTC and prescription lighteners and brighteners; hydroquinone is the most common, but kojic acid, azelaic acid, and others are also available

10. Anti-Aging products -- vitamin-A derivatives that are either OTC ( retinols) or prescriptoin (retinoids) that have a myriad of benefits including exfoliation, reduction in hyperpigmentation, building collagen, and unplugging pores 

11. Skin Soothers -- often botanicals and/or products containing caffeine to reduce redness and inflammation in the skin

12. Eye Creams -- products with a variety of ingredients to reduce the appearance of fine lines, wrinkles, and puffiness around the eyes

13. Neck Creams -- products with intense moisturizers and collagen builders to reduce the appearance of crepey skin on the neck

Whew! That was a lot. The next series of posts will address the most common skin types we see in the office and what types of products from the list above are generally best for these skin types.

Nashville Dermatologist -- Kybella available now!

We are excited that we are now offering Kybella® at Traceside!

What exactly is Kybella®, you might ask? It is a new injectable medication that targets sub-mental fullness, or "double-chin," and it is a first-in-class medication to address this difficult-to-treat area.

One of the most exciting things about Kybella® is that it is non-surgical -- no need to undergo surgery or aggressive laser procedures, if you are unhappy with this particular area. Prior to Kybella®, patients who wanted to address their sub-mental fullness needed to undergo liposuction or other invasive procedures. 

Kybella is performed as a series of 2-4 treatments, each 4-6 weeks apart. After the skin is properly cleansed, numbed, and marked, Dr. Valet injects very small amounts of the medication directly into the fat pad, where it works to slowly dissolve the unwanted fat over time.

If you are interested in Kybella, call our office to set up a consultation. And for a limited time, we are able to offer a $400 rebate through Brilliant Distinctions for our patients who purchase their first two treatments of Kybella® as a package.

Enroll in Brilliant Distinctions for free today and start earning points towards future treatments!

https://www.brilliantdistinctionsprogram.com/

Nashville Allergist -- Summertime Allergies in Nashville: What's Itching You

If you have nasal and/or eye allergy symptoms, or your asthma is flaring this time of year, you may have wondered what you are reacting to. Below are some pictures taken today and fun facts about common allergenic plants in the Nashville area this time of year.

Grasses are prominent allergens in Nashville from late spring until fall frost. These include Northern pasture grasses (Kentucky blue grass, fescue, Timothy, and others), as well as more heat-loving grasses like Bermuda grass, Johnson grass, and Bahia grass. This is one of the reasons I point out when asked why allergies are so bad in Nashville; we are on the border between Northern and Southern grasses and consequently have both!

Johnson grass is instantly recognizable this time of year. It looks like regular grass, just scaled up. Here is a nice stand, some of which is over 6 ft tall. It is in the same genus as sorghum (as in sorghum syrup) and is also closely related, as its appearance suggests, to corn and sugarcane. It spreads by runners and quickly establishes itself in unmowed areas.

The other prominent group of summertime allergens apart from grass is weeds (by which allergists mean non-grass, non-tree plants that are important causes of allergy). We are not into ragweed season yet (more to come on this when it starts pollenating in August!), but a number of other weeds are contributing to allergy symptoms this time of year. Below are pictures of two of the most common weeds, English plantain and black seed plantain. These closely related plants grow very well in disturbed soil, and consequently are found close to us in our yards, gardens, and mowed fields.

English plantain (center of the picture) in its natural environment--nestled among other plants in a lawn. Its fondness for disturbed soil makes it a marker for human activity, and the remains of its pollen in sediments is used as evidence of ancient human agricultural activity. The fact that it grows well near to us contributes to its importance as an aeroallergen.

Black seed plantain, also nestled in a lawn. This native of North America is one of the most common weeds in our lawns and also a contributor to summertime allergies.