Hair, Skin & Nails: The Window to Your Health with Dr. Melissa Piliang

Podcast Transcript

Nada Youssef: Hi, thank you for joining us. I'm your host, Nada Youssef, and today we have Dr. Melissa Piliang, dermatologist here at Cleveland Clinic. Thank you for being here. And this month we're celebrating women. Our goal is to put you back on top of your own to-do list. You take care of your household, your work, your kids, spouse, parents, even your pets, but before taking care of your own self. So consider this not your so-subtle reminder to put you first. And this month we're designating all of our Facebook Lives to help you put you in the center of your own life.

Nada Youssef: So this, of course, covers your mind, body, and soul, and today we're gonna kick it off by talking about hair, skin, and nails. And of course, before we get started, please remember this is for informational purposes only and not intended to replace your own physician's advice. So thank you again for being here, and I'll give you a few moments to introduce yourself to our viewers.

Melissa Piliang: Thank you. I'm Melissa Piliang, I'm a dermatologist and a pathologist here at the Cleveland Clinic. I take care of women in my practice, a lot of women who have hair loss, androgen disorders, acne, and those types of things.

Nada Youssef: Sure, great.

Melissa Piliang: It's a pleasure to be here.

Nada Youssef: Thank you. All right, so hair, skin, and nails are like the window to our health. You know, sometimes it means that you're deficient in something, there's so many questions that we're gonna be covering regarding symptom management. But first I want to dig a little bit deeper and talk about what these symptoms mean. And to help us and our viewers kind of like tell us what our body's trying to tell us, right? And talk about how to evaluate and read our own bodies. So first I want to talk about, a lot of solutions are from the outside in. You know, lotions, shampoo, products, things like that. But can we talk about our diet? What we eat versus what we don't eat that can cause this? Can you talk a little bit about nutrition and how it relates?

Melissa Piliang: Yeah, nutrition is very important for skin and hair and nail health. It's the foundation of our wellness, and you know, people try to follow fad diets, extreme weight loss diets, elimination diets where they cut out large categories of food. That can really get you into problems with your health. So I usually recommend a well-balanced diet. The Mediterranean style diet that's best for your heart and your brain is also the best for your skin. You want to eat healthy whole grains, you want to eat lean proteins like fish and chicken and eggs and nuts and beans, and you want to eat lots of fruits and vegetables of, a rainbow of colors of fruits and vegetables. And remember that fats are important for your skin and your hair, so healthy fats like avocados and olive oil are good.

Nada Youssef: Great. Great, excellent. Now, to talk a little bit about how to boost our vitamin intake when it comes to some of these deficiencies, so like a vitamin D deficiency. I know, you know, we live in Cleveland, I don't think we get much sunlight. But can you talk about what that causes and what we can do to help?

Melissa Piliang: Yeah, it's really common to have vitamin D deficiency. I check many patients and I find it very, very often that patients are low. And we think that vitamin D comes from the sun, and it does. If you are out in the sun in the midday for about 10 minutes without sunscreen, if you're light-skinned and your arms and legs are exposed, that would give you enough vitamin D. But here in Cleveland and other northern latitudes, the sun is not high enough in the sky from about early November through the end of February to even produce vitamin D in our skin.

Nada Youssef: Wow.

Melissa Piliang: And we know the rest of the time the sun doesn't shine a lot here in Cleveland, so you really have to think of other ways to get it. So diet is an excellent way to get it, so you can do vitamin D-fortified milk or dairy products, have a lot of vitamin D. Fish like salmon has vitamin D in it, and supplements are a really good source for vitamin D.

Nada Youssef: Great, great.

Melissa Piliang: If you're gonna do a vitamin D supplement, you should make sure you take it with a fatty meal. So vitamin D is one of those fat-soluble vitamins, and I find patients on low-fat diets, even with the supplement, don't always get their level up enough. So it's really important to take it with a fatty meal.

Nada Youssef: Okay, now when you say fat-soluble vitamins, can you explain to me and the viewers what that means?

Melissa Piliang: Yeah, so that means the vitamin ... like if you took a vitamin D capsule and opened it, it would be like an oily substance in there. So it's an oily vitamin, so you have to have ... like think about your salad dressing and how oil and water separates. So if you take it with water or something that's not fatty, it doesn't absorb well, just like in your salad dressing. So you want to take it with a meal with some fat so that can help the vitamin D get absorbed.

Nada Youssef: All right, interesting. Very, very interesting, thank you. Well, since we're talking about deficiencies, I'm gonna kind of go down a list of, the same kind of description that you just did was very helpful. I know B12 is a big one, I know people, you can only get it by a shot, is that correct?

Melissa Piliang: So generally via shot. Most people do okay with B12. Unless you have an autoimmune disease called pernicious anemia where the special cells in your stomach that absorb it are missing, then you could be anemic or you could have a rash. But generally people do okay with vitamin B12. But you can get B vitamins from whole grains, it's a good source.

Nada Youssef: Okay, great, great. And let's see, what about vitamin ... well, we talked about vitamin D. What about iron?

Melissa Piliang: Iron is very important for women, especially women who are child-bearing age and who have monthly periods and probably don't get a lot of iron in their diet. So many women avoid red meat, which is our best source of iron. And then when you have periods or if you're a heavy exerciser, so you're a runner or you're doing a lot of aerobic exercise, that causes little tears in your joints or the lining of your stomach, that can lead to some anemia or loss of iron that way. Iron is really important for hair growth and hair health, so that's one of the screening, for the labs we do for patients who are losing their hair. And it's not uncommon for us to find it to be low in women.

Nada Youssef: Sure, sure.

Melissa Piliang: So eating red meat, that's your best source of it. You know, a portion of red meat a couple of times a week should be enough. Beans can have iron in them, spinach is a vegetarian source of iron, and other dark leafy green vegetables. Or a supplement.

Nada Youssef: Great, I'm writing all these down. This is very good information, thank you. And then how about some zinc deficiency? 'Cause I know when I was younger I used to always have that white speck on my nails and I never knew why, and so I looked it up and it said zinc deficiency. Well, where do I get zinc? What is zinc doing to my body? So can you describe a little bit about that?

Melissa Piliang: Yeah, yeah, zinc is really important for wound healing, skin health, hair health, nail health, and the common sources, again, meat, especially red meat, is a good source of zinc. Pumpkin seeds have zinc in them, or you can take a supplement.

Nada Youssef: How about oysters? I've heard oysters are good for zinc?

Melissa Piliang: They have zinc in them also, but I don't know that many people that are eating enough raw oysters to be able to ...

Nada Youssef: Sure, sure, it's a different one.

Melissa Piliang: Get their zinc. But zinc is another one, you lose zinc in sweat, so people who are, again, heavy exercisers, people who do hot yoga where you sweat extensively for an hour or 90 minutes, you can run down your zinc level that way, too.

Nada Youssef: Very interesting.

Melissa Piliang: So if you are somebody who sweats a lot and is a vegetarian, maybe think about adding zinc.

Nada Youssef: So that's how you're losing your zinc, is through your sweat, wow.

Melissa Piliang: That's one way you can.

Nada Youssef: Very interesting, very interesting. Okay, and then vitamin A. Is that, I know we don't think about vitamin A a whole lot. Where do you find that, do you need that for ...

Melissa Piliang: Yeah, vitamin A is important. It's really important to be at the right level.

Nada Youssef: Sure.

Melissa Piliang: Too much causes a problem, too little can cause a problem. So you want to be kind of right in the middle on it. And you know, vitamin A is an interesting one. It's one that we use to treat things like acne.

Nada Youssef: Really?

Melissa Piliang: So Tretinoin, a common acne medication, is a form of vitamin A.

Nada Youssef: Very interesting. Now, is vitamin A something you can find in food?

Melissa Piliang: It is, it is, or a vitamin supplement.

Nada Youssef: Okay, or supplements.

Melissa Piliang: I think you have to be very careful not to overdo on vitamin A. Remember, you have to be in the right balance. So especially vitamins that are meant for eye health, they have extra vitamin A. So be very careful that you're not overdoing it.

Nada Youssef: Very interesting, so how do we know, like if I'm deficient in vitamin C. How do I know what supplement to get? Because the store has so much stuff, is it real, is it fake, the prices vary. How do I know what to choose?

Melissa Piliang: Right. I think for most people who are eating a regular healthy diet, they're probably fine, really, for most things. But if you feel like you want to take a supplement, I think a multivitamin is a great way to fill in any gaps in your diet. You know, most of us get enough calories, most of us are not, you know, have enough food, but we may not be getting the variety we need every day.

Nada Youssef: Yeah, right.

Melissa Piliang: So adding in a multivitamin can really help to fill in the gaps. I think the ones that you can find in a drugstore for a reasonable price are fine for most people.

Nada Youssef: Great, so Mediterranean diet, we got red meat, we got some healthy fats, and we got some nuts and seeds, keep eating those kind of foods. Great, so I'm gonna jump onto hair. What are the biggest factors for hair loss? Because that's, I think, one of the biggest thing men and women look at as the biggest downfall.

Melissa Piliang: Yeah, yeah. So genetics plays a big role in it.

Nada Youssef: Genetics.

Melissa Piliang: So if you have parents who have thinner hair, then you will likely have thinner hair. Nutrition like we've been talking about is very important for hair. So eating enough protein, so I usually recommend 60-80 grams of protein a day for good hair growth. And you know, that's not hard to do, but it's really easy to not do it.

Nada Youssef: Right, right. It's critical.

Melissa Piliang: So you have to think a little bit about what you eat. And you know, if you're somebody who's eating kind of a bread and pasta diet, then you're probably not getting there. But if you eat some chicken and some eggs and dairy, you can get there pretty easily.

Nada Youssef: Excellent. Can we talk a little bit about biotin? I've heard a lot about biotin. First of all, how do you know if you're deficient, and what is it good for?

Melissa Piliang: Yeah. So biotin is really important for hair and nail growth and skin health. It's a water-soluble vitamin, so if you ... that's one that if you take too much your body will just excrete it, so it's a safer one just to take if you feel like you might be low. If your nails are splitting or breaking or seem weak, then taking some biotin can help. That'd be a good first step.

Nada Youssef: Great. And I'm gonna go ahead and jump onto Live, 'cause we're actually getting many questions already. So I have Kinga. "What helps for losing hair?" And we just kind of talked about this a little bit.

Melissa Piliang: Yeah, yeah. So we talked a little bit about some of the things that can cause it. Stress is also a fairly common cause of hair loss. Having surgery, certain medications, in women hormonal abnormalities like problems with the thyroid or problems with male and female type hormones that can be out of balance can do it. So if you're shedding, it's important to try to figure out why. It's a sign that there might be something else going on. So seeing a dermatologist might be a good idea, just to see what else you can do. If it's more that you're in your 40s, approaching 50, maybe you're post-menopausal and you notice that your hair's thinner than it used to be but you don't really see it falling everywhere, it's more kind of a slow onset process, then using something like Minoxidil can be a great solution.

Nada Youssef: Minoxidil.

Melissa Piliang: Minoxidil.

Nada Youssef: Okay.

Melissa Piliang: That's available over the counter, either as a foam or a liquid.

Nada Youssef: Okay.

Melissa Piliang: And it has been shown in good studies to regrow hair in both men and women. It takes about six to nine months to see the effect, so you have to be a little bit patient with it, but keep using it. And it really is very safe and works quite well.

Nada Youssef: Great. Now, I want to ask you kind of, if someone's in the shower and washing their hair, what is natural to have some hair come out of you and shed versus like "Whoa, this looks like a big chunk, I should get it checked out"?

Melissa Piliang: Yeah, it's normal to lose 150-200 hairs a day.

Nada Youssef: Sounds like a lot.

Melissa Piliang: It sounds like a lot.

Nada Youssef: I'm sure that's not a whole lot.

Melissa Piliang: But that can be within the realm of normal.

Nada Youssef: Okay.

Melissa Piliang: And most people know if they're shedding more than what they normally shed. And you know, if you just one day have that and then it's back to normal I wouldn't worry about it. Even if it's a few weeks, we tend to shed seasonally, that's probably okay too. But if it's been going on for several weeks or a month, two months, and you're ... especially if you're not feeling well in another way, it's really important to get it checked out.

Nada Youssef: Get it checked out. Great, thank you. And then we have Hannah. "Hi there, I have ezcema and ..."

Melissa Piliang: Dermatomyositis.

Nada Youssef: Thank you, "I am struggling to tell the difference between the two types of rashes, especially as I have started getting blisters forming on my hands. Do you have any tips on how to identify the differences? Thank you."

Melissa Piliang: Oh, Hannah, dermatomyositis is a tough problem and often very itchy, just like eczema. My suggestion is that you should see your dermatologist and let them help you try to decide what you're dealing with. 'Cause that's a hard one, even for a dermatologist to tell the difference.

Nada Youssef: Really?

Melissa Piliang: They're all red, they're scaly, they're itchy, there's a lot of overlap. So I would say see your-

Nada Youssef: So there's no way you can do it yourself, go see a specialist?

Melissa Piliang: If you're not sure, you know, one thing is if you've had eczema for a long time and you know what the eczema looks like, then if it doesn't look like that, it's probably the dermatomyositis. But if you have dermatomyositis, you should be seeing a dermatologist and they should be able to help you differentiate those two things.

Nada Youssef: Okay, great. And then I have Eddie. "What is the best treatment for rosacea?"

Melissa Piliang: So rosacea is an acne-like eruption on the face, where people can get red bumps or little pustules. Sometimes their face is red or they flush and blush easily, you can get dilated blood vessels. So there are a number of treatments that you can use. There are some topical creams like Metronidazole, is a good one. But they're really prescription creams, so I would say if you really want treatment, see your dermatologist. But some good skin care things that can help rosacea are using a good moisturizer a couple of times a day, that helps with the sensitivity that patients can feel. Washing your face with a gentle cleanser, not anything harsh. I would avoid ingredients like salicylic acid in benzoyl peroxide that we think about for other types of acne, 'cause that might make it worse.

Nada Youssef: Oh, okay.

Melissa Piliang: And wearing sunscreen regularly, 'cause sun can contribute to rosacea. The last thing I talk about with that is, some people notice that foods and drinks can make their rosacea worse. It makes them flush and blush. Things like hot coffee in the morning or spicy foods or hot soup or alcohol can all make this problem worse. So you could get a list of triggers of rosacea and eliminate those from your diet and see if that has any affect for you. Even just drinking your coffee a little cooler instead of drinking it steaming hot.

Nada Youssef: So that would make a difference, you mean the temperature itself, not the coffee?

Melissa Piliang: Yes, the temperature can help. It may be something else in the coffee, like the caffeine, but the first thing, if you can't give up your coffee, just try drinking it a little cooler temperature and see if that makes a difference.

Nada Youssef: Great, very good information. And then I have Eleanor. "I'm low on vitamin D. Can that cause hair loss?"

Melissa Piliang: Yeah, vitamin D is really important for hair growth, and it's also important for hair regrowth. So the hair goes through phases. We have a very long growing phase and then a short shedding phase, then that hair cycle resets and goes back into the growing phase. Vitamin D helps push it from that resting, shedding phase back into the growing phase so new hair will emerge. So yes, vitamin D can be contributing to your hair loss, so I would recommend that you replete that, take a supplement, get your levels back up.

Nada Youssef: Sure, sure. All right.

Melissa Piliang: And I think the other thing about vitamin D, it's really important to understand that it has ramifications to your entire body health. It increases your risk of cancers and heart disease and depression and autoimmune diseases. So I think that is one that we should be fixing.

Nada Youssef: Yeah, that's crucial. And then I have Misty. "I'm in my late 20s and I have a lot of gray hair while my friends have none. Is this genetic or is there something I can do to prevent gray hair without coloring?" You want to stay healthy.

Melissa Piliang: Yeah, I remember I had a friend in college who, we would pluck out her few gray hairs.

Nada Youssef: Well, aren't you not supposed to do that? That's what I've heard, is that a myth?

Melissa Piliang: Which is not, no, but we were ... yes, well, so it doesn't ... no, you should not.

Nada Youssef: Okay.

Melissa Piliang: Plucking it doesn't give you more grays, but more grays are coming.

Nada Youssef: Are coming the same ... okay.

Melissa Piliang: Right, but it just doesn't do any good and it makes you lose hair, so you're better off just to keep it, or use one of those little ... there are hair coloring wands that you can buy, so you can just color like an isolated hair or a few hairs. Like if you have one that's showing, rather than pluck it.

Nada Youssef: But once you have the gray hair there's no end, there's no reversing it.

Melissa Piliang: There's no reversing it right now.

Nada Youssef: Sorry, Misty.

Melissa Piliang: But, and it is primarily genetics. You know, there may be some environmental factors that make it so that maybe you gray a little bit earlier or later than what your genetics determine. So you know, we don't know what those are, but it may be things like stress or pollution, or there may be something nutritionally, but right now I think the best thing to do is to color it.

Nada Youssef: Yeah, sure. Now, you mentioned environmental factors. Can you talk a little bit about that? Like how does it factor in, can you talk about maybe the pollution, whatever we're eating, pesticides, anything like that? How is that affecting us?

Melissa Piliang: Yeah, so I think the answer to that is we don't totally know all the ways that it's impacting us. But we know it probably is. So we have our genes, but then that doesn't tell the whole story about us. So the other things that happen to us throughout our lives can have an impact on how our genes relay into what we see or react to it. So you know, for hair at least, there's been studies done looking at men, a cohort of men and men who had higher-stress professions had less hair than men who had lower-stress professions.

Nada Youssef: Oh, so stress definitely.

Melissa Piliang: Suggesting that stress might play a role. Certainly nutrition is very important, and that probably plays a role. People with better nutrition have better hair.

Nada Youssef: Of course.

Melissa Piliang: And you know, there's probably some minor play in that and people in our society who are healthy overall, but if you look at societies who go through famine periods or people who have been through horrible times of war, where their stress is high and nutrition is, food is scarce.

Nada Youssef: Sure, sure.

Melissa Piliang: They certainly have less healthy hair than somebody who didn't have to survive through that.

Nada Youssef: Does sleep play a factor in this at all? Lack of sleep?

Melissa Piliang: Sleep is very important.

Nada Youssef: 'Cause they call it beauty sleep, right? And I wonder if that actually is true.

Melissa Piliang: Yeah, so sleep is really important for health overall. It's also important for stress and managing cortisol levels. So higher cortisol levels impact your hormones in a way that could lead to more wrinkles.

Nada Youssef: It's all connected, it's all connected.

Melissa Piliang: Yeah, so eat well, exercise regularly, and get a good night's sleep.

Nada Youssef: It sounds good. And then jumping on to Elizabeth. "I have best brand of sunscreen. I break out easily on my face."

Melissa Piliang: Yeah, so sunscreens are a hard thing. You go to the store and there is an entire aisle full of sunscreen. Who knows which one to pick?

Nada Youssef: Right.

Melissa Piliang: I think the best sunscreen is the one that you actually put on your skin.

Nada Youssef: Okay.

Melissa Piliang: So some of them, some people really like sprays and some people hate sprays. And some people really like the little stick, 'cause you put it on and it really sticks nicely. Or a cream, whatever it is, it has to be something that you'll actually put on your skin.

Nada Youssef: Sure.

Melissa Piliang: But when you're looking at that aisle, the place to start is you want to look for something that has at least an SPF of 30. You want to look for one that is broad spectrum. That means it blocks both UVA and UVB rays. UVB rays cause cancer, and that's what makes you burn. UVA rays cause cancer and aging, they penetrate ...

Nada Youssef: Wrinkles.

Melissa Piliang: Wrinkles, they penetrate a little bit deeper to the skin. So you really want to make sure your sunscreen blocks both of those.

Nada Youssef: Okay. Should you be using it daily? Like is the SPF thing like something I should be looking in my makeup, in my lipstick, is it something I should be putting on daily even if it's cloudy today in Cleveland?

Melissa Piliang: Yeah, I think it's a good habit to put on daily on exposed skin. So for us and people who are going to work, on your face as part of your habit. Because you know, we do walk to our cars outside, you go to the store, you might walk, you might run into your friend and stand and talk for five or 10 minutes, and you can get a lot of sun exposure in that time period. There was a study done looking at women, and half of them had a lotion without sunscreen, half of them were given a broad spectrum sunscreen to put on every day. And they relooked at those women at the end of the year, and after one year the women who were using the broad spectrum sunscreen every day looked younger than the ones who weren't, and looked younger than when they started.

Melissa Piliang: So if you want to do something to help make yourself look younger, use your sunscreen every day.

Nada Youssef: Okay, done. All right, and then I have Maggie. "Hair loss and rosacea. Metronidazole not working for rosacea, better or improved treatments available?"

Melissa Piliang: There are other treatments. There are some washes, there are some topical products, there are antibiotics. Some people need a course of antibiotics to really clear it up.

Nada Youssef: Sure.

Melissa Piliang: So if the Metronidazole isn't working, then I'd go back to your dermatologist and see what else they have to offer.

Nada Youssef: Okay, great. And then Marie is asking about any special skin care for diabetics.

Melissa Piliang: Oh, so yes. You know, diabetic skin is more fragile than people who aren't diabetic. And they can have changes to the nerves in the feet that make them not feel as much, especially if they injure themselves.

Nada Youssef: Right.

Melissa Piliang: So it's really important to take good care of your feet, to make sure you don't have any wounds on there that you don't know about, any sores. And be careful when cutting your toenails. Cut your toenails well so you don't get an ingrown toenail.

Nada Youssef: All right, great. "How can you remove stretch marks?" Or can you remove stretch marks?

Melissa Piliang: You can't really remove stretch marks.

Nada Youssef: All right, okay.

Melissa Piliang: But you can help to make them feel better and look better. I mean, initially stretch marks tend to be bright red and really visible. When they're in that phase, then sometimes using a topical, Retinoid, that's one of those topical vitamin A creams that we talk about, can help. Sometimes lasers can help when they're bright red.

Nada Youssef: Okay.

Melissa Piliang: But if you wait six months or a year, they tend to fade out to white. Then they're less visible, but still there. And there are some things like lasers or micro-needling, there are some things that can be done that might improve the appearance.

Nada Youssef: So it would need to be a procedure to improve, not completely take away.

Melissa Piliang: Not completely take away.

Nada Youssef: Nothing, not like coconut oil or coconut lotion, okay.

Melissa Piliang: No, right.

Nada Youssef: And then Robin, "I just removed my fake nails and now I see a green spot under my nail. What could it be?"

Melissa Piliang: Yeah, I would be worried that that could be an infection.

Nada Youssef: Okay.

Melissa Piliang: So I think that's something that should take you to a dermatologist to get checked out.

Nada Youssef: Right away, you should definitely get it checked. If it was not there before.

Melissa Piliang: No. And if it's under your nail it's not really something that you're going to be able to.

Nada Youssef: I see. What is under the nail? Let's talk about that. I mean, that's your skin, is that, that's infected by the utensils that's being used, is that the infection that's coming with ...

Melissa Piliang: It could be, it could be. When we think, as dermatologists when we hear that it looks green, we think about a very certain bacteria that can make things look green. But it could also be a fungus, too, that can grow, kind of make a home under the hard part of your nail, which we call the plate. Underneath there, and kind of create a little space to grow and have a little happy life.

Nada Youssef: Now what causes nails to be like yellow, or not like perfect-looking? What is the yellow, the off-color on nails? And I'm sure there's probably a million things that factor into that.

Melissa Piliang: Yeah, so sometimes it can be things like problems with your liver or your kidneys can make your nails look yellow. Sometimes people who have problems breathing, their nails can look white or yellow. Smoking can make your nails look yellow.

Nada Youssef: Of course.

Melissa Piliang: And then sometimes it's stains from nail polish. So if you wear a lot of red nail polish, that can stain your nails and make them look kind of yellow. So if you have that, if you feel like your nails look yellow, I would stop smoking, stop using your nail polish for a little bit and let it grow out and see if it doesn't help.

Nada Youssef: Great. Okay, and then Tracy's asking "Is there a safe way to pop a pimple?"

Melissa Piliang: Pimples are best left alone.

Nada Youssef: Okay, good to know.

Melissa Piliang: You increase your risk of scarring if you try to pop them. If you have one that ... you know, especially, you don't want to pop the deep ones, you don't want to try to mess around with those real deep ones, they will leave you a terrible scar. If you have one that has a big pus right at the top and you really just can't stand it and you want to get rid of it, if you use a warm compress first for five or 10 minutes to kind of soften it up, you know, alcohol, then kind of gently squeeze and it'll ... if you have to squeeze very much then just don't. Leave it alone.

Nada Youssef: Leave it alone, okay. I know they look enticing.

Melissa Piliang: And they look enticing and it's really hard. You know, it's interesting, there are studies that have been done looking at the treatment of people who have skin abscesses, like you can get from a cyst, which is kind of like a big pimple. And people, if you drain an abscess, it heals as well or almost as well for most people as if you gave an antibiotic.

Nada Youssef: Wow.

Melissa Piliang: Okay, so just draining it can be enough to really help it heal. So we probably have some vestigial reflex, some reflex from back when we were cave people, that makes us want to pick things off our skin, because it was probably a survival advantage. So if you were out there, you didn't have a doctor to go to, but if you had something on your skin that you picked off, it might give you a survival advantage. So I think we have some of that left in us somewhere, that we want to pick things off our skin. And so I think that's why we want to do it. So if you can understand that but just know that you can't, that's not the right thing to do for your skin.

Nada Youssef: Sure, great. This is very helpful information, thank you. And then Rhonda. "I noticed my derm office offers cool sculpting. Does it work?" And before I even have you answer this, can you explain a little bit what is cool sculpting? We've heard about it.

Melissa Piliang: Yeah, cool sculpting is a way to diminish fat in very specific areas. It goes on a principle, pediatricians first described this. We used to see kids who would get like big red nodules on their face after they ate a lot of popsicles. It was from the cold that would cause a little inflammation in the fat. After that went away, they'd have a little depression. And in little kids it would come back and they would be fine. They would get like a little dimple there. So based on that principle, it was thought "Well, maybe we could get rid of subcutaneous fat for people that way."

Melissa Piliang: So cool sculpting uses a specialized machine that cools the fat while protecting the skin, so you don't freeze the skin, you just cool the fat to the point where it will kind of become inflamed, and then slowly over a few months get reabsorbed by the body. So it can help if you have very fat-resistant areas. So it's best for people who are like within 15-20 pounds of their goal weight.

Nada Youssef: And it's a permanent solution?

Melissa Piliang: Well, if you gain weight, you could eat it back. You can eat enough to get it back.

Nada Youssef: Yeah, right, you can always eat it back.

Melissa Piliang: Yeah, but if you maintain your healthy diet and exercise regimen, then it should be a permanent solution. And it's really good for belly fat, that's where it was first described. Love handles, sometimes saddle bags, those kind of areas.

Nada Youssef: The ones that are hard to get rid of.

Melissa Piliang: Hard to get to, yeah.

Nada Youssef: Okay. Great. And then, we're almost out of time but I'm gonna ask you one more question. It's melanoma awareness month, so I want to talk a little bit about moles. About, if I have a mole, you know, I get these little dots that I've never had before. How can I tell one looks dangerous and should be checked out versus there's so many moles on me I just can't tell the difference?

Melissa Piliang: Yeah, well, I think it's important first to get to know your skin. Look yourself over head to toe, so you take inventory. You know what moles you have and what they look like. Then you should do that every month. And the things that you're looking for is, first of all, new moles or anything that's changed. That should draw your attention. Then you want to look, we talk about the ABCD rules of melanoma.

Melissa Piliang: So A means asymmetry, it means one side doesn't look like the other. So it's not a perfect circle. B stands for border. The border might be irregular or scalloped or there might be a divot in it. C is for color. So it's not a uniform color, it has dark brown, black, pink, red, white, blue in it. Then you should really be worried. And D stands for diameter, that's the size. So most melanomas are bigger than six millimeters. That's about the size of a pencil eraser.

Nada Youssef: Okay.

Melissa Piliang: So if you have bigger moles, that's something else to worry about.

Nada Youssef: Okay.

Melissa Piliang: And if you see anything, then you should have your dermatologist ...

Nada Youssef: Anything unusual, get it checked out.

Melissa Piliang: Yeah, get it checked out.

Nada Youssef: Okay, great.

Melissa Piliang: And the other thing I would say, especially anything that bleeds, that itches, that has grown quickly, get that checked out.

Nada Youssef: Okay, and now odd question. I've seen people with like one hair sticking out of a mole. Does that mean any kind of changes, is that something to be worried about?

Melissa Piliang: It's generally a good sign, actually.

Nada Youssef: Is it? It's growing.

Melissa Piliang: Yeah, because it's ... yeah, it's growing, it's doing what it should be doing.

Nada Youssef: Ah, that's very interesting. I didn't think about that.

Melissa Piliang: Yeah.

Nada Youssef: Great, well, we're kind of out of time, but before I let you go is there anything you want to let our viewers know that may be something we haven't touched on?

Melissa Piliang: I think it's just really important to wear your sunscreen, do your self-skin exams, you know, most melanomas are caught by the patient. So look yourself over, and look over your partner. Married men, their melanomas are caught earlier and they have a survival advantage. So look over your friends and your partner.

Nada Youssef: That's because their spouse is checking out their skin?

Melissa Piliang: Well, that's the theory, that's the thought.

Nada Youssef: Oh, very good.

Melissa Piliang: So the theme for skin cancer awareness month, the skin cancer hero. So be a skin cancer hero, help your friends and ...

Nada Youssef: Help your loved ones and your family members, great. Well, thank you so much for coming in today. It's been very, very insightful.

Melissa Piliang: Yeah, thank you.

Nada Youssef: And for our next topic we actually picked for the You First focused Facebook Live, will be women's sexual health. We will have a gynecologist and vice chair of obstetrics, gynecology, and women's health in situ, Dr. Linda Bradley, alongside psychologist and sex therapist Dr. Dana Brendza, so make sure you guys tune in. And you can also visit ClevelandClinic.org/YouFirst to get health advice from Cleveland Clinic woman experts and tips to help you take care of yourself first. Thank you so much again for watching, and we'll see you again next week.