Help for Common Skin Concerns with Dr Christine Lopez

Podcast Transcript

Nada Youssef: Good morning and thank you for joining us today. I'm your host Nada Youssef and today, we're speaking with dermatologist. Dr. Christine Lopez. We're taking all your questions regarding skin care issues or dermatology issues. But before we begin, please remember that this is for informational purposes only and this is not to replace your own physician's advice. Thank you so much for coming today.

Dr. Christine Lopez: Of course. Thank you very much for the opportunity to share my knowledge about dermatology to the community.

Nada Youssef: Thank you. Thank you. Do you want to give us a little bit of your background?

Dr. Christine Lopez: Of course. I'm Dr. Christine Lopez and I joined the Cleveland Clinic in 2000 to pursue my Mohs micrographic surgery fellowship. Prior to that, however, I completed my dermatology residency in the Philippines at the Skin and Cancer Foundation in Manila. After my fellowship, I redid my residency here at the Clinic in order to be board-certified in the United States. Since then, I've been practicing at the Clinic, focusing my practice on skin cancer management, dermatologic surgery, and cosmetic dermatology.

Nada Youssef: Awesome. Great, thank you. Well, let's go ahead and start with our first question. We have a question from Brandon. "I'm getting small, white bumps around my eyes. What are they and how do I get rid of them?"

Dr. Christine Lopez: Good question to start with. White bumps can be a number of different things. I think this is where a visit to your dermatologist would be necessary because you can only imagine, there are a number of benign growths that can appear around the eyes, but more importantly, there are some of these benign growths that can be signs of something else going on in your body that needs to be addressed. A visit to a dermatologist is what I would recommend to figure out is this a syringoma, is this a milia, is this a variety of other benign conditions. Xanthelasma, which can be related to your cholesterol levels. A visit to a dermatologist definitely recommended.

Can we remove them? We do have some lasers that we can use to help flatten them, but because a lot of these growths actually go deeper in the skin, the attempt to remove them completely may leave you with scars, so we don't like to completely remove them. We can use particular procedures to help flatten them but not necessarily completely remove them.

Nada Youssef: So, to even them out, just not completely off due to scarring? Great.

Dr. Christine Lopez: Exactly.

Nada Youssef: I have another question from Jim. "Are there certain foods or ingredients that I should avoid for breakouts on my skin?"

Dr. Christine Lopez: Still a controversial question. There's definitely some studies that have shown highly fatty foods, foods in high sugar, that can contribute to acne, but these are not what we call randomized, controlled trials that account for a lot of different aspects to ensure that we are making particular recommendations based on evidence. So, the jury's still out there in terms of diet and acne.

Nada Youssef: Great. All right. Then we have Kim. "Can you explain what type of sunscreen is best? Should I be wearing waterproof or water resistant? Is there anything over SPF 30 or anything less than SPF 30, is it useless?" Then I'll add to that about spray tans because I know there's a lot of spray tans, people say do you rub them in, do you spray them in, and is that at as well useful?

Dr. Christine Lopez: Sun protection and sunscreen. I think you made a good point by saying, "Is it useless to use anything SPF 30 and above?" What I normally tell my patients is, more importantly, is to put on a sun protection on a daily basis. It's not just to put it on when you're going out on the beach or out in the pool, it's making a habit of using sun protection on a daily basis.

For everyday life in Cleveland, SPF 30 and above would be adequate, but if you are going to be outdoors, watching your kid's soccer game or going out in the pool, I would use SPF 50 and higher. Although it doesn't give you significant improvement in terms of protection, it's the amount of time that you're able to keep it on without having to reapply that changes. So for an SPF 30, I would reapply it every two, three hours if you're outside. If you're putting on an SPF 85 or 100, an hour or two.

Nada Youssef: Okay.

Dr. Christine Lopez: I'm sorry. Longer.

Nada Youssef: Opposite.

Dr. Christine Lopez: Longer.

Nada Youssef: Right.

Dr. Christine Lopez: But I think the biggest problem is not really choosing whether it's SPF 30 or 85, it's choosing one that you'll like the texture, the smell, enough to use it on a daily basis. I tell my patients, much like you brush your teeth first thing in the morning? Put on that sun protection so you know that you're protected. Because even in our cloudy days here in Cleveland, which are many, the sun still goes through the clouds. The sun goes through the windows of the car, windows at home, and I would jut be protected on a daily basis by putting that sunscreen on first thing in the morning.

Nada Youssef: So don't not just when we're going to the beach of going out.

Dr. Christine Lopez: Correct.

Nada Youssef: This is a daily habit.

Dr. Christine Lopez: Absolutely. In fact, put it on 30 minutes beforehand, because many of our sunblock are chemical sunscreens, which need some time to be on your skin to be effective. There are also some physical sunblock, like zinc oxide based or titanium oxide based sunblock, that are physical sunblock. Those don't need to be on your skin 30 minutes before it can be effective, but nonetheless just get in the habit of putting it on before you even go out and venture.

Nada Youssef: Very interesting. Thank you.

Dr. Christine Lopez: You talked about suntan, spray tan.

Nada Youssef: Oh, spray tans, yes, yes. Right.

Dr. Christine Lopez: Spray tans. So, spray tans. What's important about spray tans is the fact that they don't protect your skin from the sun. Okay. They're merely there to give you color.

Nada Youssef: I see.

Dr. Christine Lopez: If you think that putting on a spray tan is sun protection, it isn't. Do you spray it, do you put it on? It doesn't really matter. I think what's important is how it makes you look, because that's all there is to spray tans.

Nada Youssef: That's all there is.

Dr. Christine Lopez: Because you like the look. There are nice ones nowadays that give you a more natural look than they used to be, years past.

Nada Youssef: Excellent. Thank you. We have Steve. "I have a large scar on my arm from a surgery. Is there something I can take or apply to make it less visible?"

Dr. Christine Lopez: I always tell my patients, a scar is a scar, will always be a scar. There are procedures that we can do to make the scars less visible, but nonetheless, they will still be a scar. After the procedure, we usually tell our patients to keep the area nice and moist so that the sutures or anything can come off very easily. A scab during the healing process delays the healing and creates more scarring, so the more moist the environment is during the healing process, the better the scar will look like. After the sutures come off, keeping it nice and moist, again, with Vaseline or any of the products out there, Mederma or anything else, is merely providing moisture to the skin and to the scar, which will make it look a little better. Is it worth the hundreds of dollars? It's going to make very little improvement and I think the biggest issue here is managing expectations. You shouldn't expect the Mederma or the silicone sheets to drastically improve the appearance of the scar. Minimally.

Nada Youssef: Interesting. Great. All right, and Janet. "Psoriasis. What can be done to stop it from spreading?"

Dr. Christine Lopez: Number one, there are a number of topical treatments that we use to treat psoriasis. We use topical steroids, we use vitamin D creams. We use light therapy. Sometimes if it's extensive enough, we may opt for systemic medications like Methotrexate. But more recently, there are products called biologics, which are synthetic, human-derived products that are used to treat psoriasis and psoriatic arthritis. Those are injected medication in the areas that are involved, will help minimize its spread. But nonetheless, staying active on your treatment regimen for psoriasis is probably the best avenue to control psoriasis. Excuse me.

Nada Youssef: Great. Thank you. All right, and we have Sharif. "I have a very resistant dandruff in my hair. Any strong medications for that?"

Dr. Christine Lopez: Skin or scalp dandruff is very common. In dermatologist, we call it seborrheic dermatitis and we can see it not just on the scalp but also on the eyebrows, around the nose, ears, chest, around the mouth. We usually treat that first with over the counter anti-dandruff shampoos, but there is a antifungal product called Nizoral in a two percent formulation that is available as a shampoo as well as a cream that can be used to control that.

Nada Youssef: Excellent. Great. We have Ruth Ann. "Is there an effective repair on my nostril after Mohs surgery? I have cartilage blocking my left nostril."

Dr. Christine Lopez: Yes. We work very closely with our plastic surgery and our ENT facial plastic surgery colleagues to address issues like that. Yes, there are a number of reconstructive options that carry that side effect in the process of reconstruction, and we openly discuss that with our patients and if we need the help of our ENT or plastic surgery colleagues, we would refer you to them to help alleviate that problem.

Nada Youssef: Great. All right, and then I hae Bernie. "I am 76 years old and I have crepey skin on my arms. Can you recommend a lotion or a treatment to help with that?"

Dr. Christine Lopez: We like to use, I think similar to sun protection, putting lotion on a daily basis is what's going to help minimize that. I usually tell my patients, you know, within three to five minutes of getting out of the shower to just lather yourself up with lotion. Not only is it going to prevent dry skin, but it's also going to help hydrate the skin and minimize the appearance of crepey skin. In addition, to just bland moisturizers that are available over the counter, there are products that you may want to look for in particular that add extra moisture into the skin as well as exfoliate it and enhance the production of collagen to help minimize that crepey appearance. We look for products that contain glycolic acid, lactic acid, and there are products out there that are available over the counter. Here in the U.S., Skinceuticals, for example, may have a line of products. Aqua Glycolic, MD Forte. There are a number of products that are available over the counter as well as products that you can get as cosmeceuticals, which are dispensed out of a physician's office.

Nada Youssef: Awesome. Great. We have Judy. "I have broken spider veins on my cheeks from having them stretched during an oral surgery. Is there anything I can do?"

Dr. Christine Lopez: Yes. We actually have a vascular laser that helps target that specifically. They're called telangiectasias if they're teeny tiny. The laser targets the blood vessels, heats them up so that they collapse, but they're not getting rid of them. They're merely closing them down, so they can re-open. It's not a one-time treatment. It's usually a treatment that we would recommend every three to four months for a series of maybe three or four times, and then after that, a touch up every year.

Nada Youssef: Excellent. Great. I have a question from Joe. "I have rosacea. Is there an over the counter solution? I was allergic to minocycline and not sure about the other treatments."

Dr. Christine Lopez: Yes. Rosacea has many different variants. You can have just the pinkness of rosacea, which, that laser that I just spoke about, can address. You can also have what we call the Papulopustular variant, where you get little pimple-like lesions associated with your rosacea that flare with environmental changes, certain eating spicy foods, hot beverages, and all that. That we usually address with a topical antibacterial cream, a prescription, as well as other minocycline-like antibiotics, not primarily as antibacterial but more anti-inflammatory. In terms of over the counter products, because redness is a common theme in rosacea, we will recommend green-based tinted moisturizers that are available over the counter to cover up the red, as well as sun protection, that also aggravates rosacea.

Nada Youssef: Sure.

Dr. Christine Lopez: But yes, the green-based moisturizers can help minimize the redness that is a prominent feature in rosacea.

Nada Youssef: Awesome. Great. We have [Jolynn 00:14:01]. "I am 59 years old and still getting blackheads in the chin area, along with some acne in same areas. I need some help as to the best cure."

Dr. Christine Lopez: You may think that acne is predominantly a teen-aged condition, but it actually has two peaks. We see a lot of acne in the teenage years with the rush of hormones into the system, but was also see it in the 40-50 age range. Most commonly we see them around the mouth and again, related to hormones. We usually, when you come and see the dermatologist, we'll assess. Is the acne hormone related, and therefore we may treat that with hormone replacement therapy, prescriptions like Aldacdone. If it's severe enough, we may look to oral tretinoin or Accutane products to address them. But it's very common to get acne in the 40 to 50 age range, particularly around the mouth as it is hormone related.

Nada Youssef: Okay. Does stress have anything to do with that as well?

Dr. Christine Lopez: Stress has a lot to do with everything. A lot of skin conditions definitely are aggravated with stress. So modifying stress and getting into a healthier habit in managing your stress will only help your skin condition.

Nada Youssef: That's good. I have Sondra. "What can be done with those ugly age spots on my face? They're too dark to cover up with makeup and they make me very self-conscious."

Dr. Christine Lopez: There are many dark spots. In the dermatologist's eyes they can be just plain old freckles, which are the smaller, light brown ones. There can be something we call lentigo, or lentigines, plural, which are more well-formed dark spots or age spots, that's probably what people consider. Then there are ones that are a little thicker and those are benign growths called seborrheic keratoses. Depending on what these brown spots you're talking about, there are things we can do. Sun protection can help the freckles and the lentigo or lentigines, but not the seborrheic keratoses or those benign growths, the thicker ones. The age spots that are flat can be improved with the use of liquid nitrogen, for example, and then we also have some different lasers that can help address these brown spots as well as topical bleaching creams. Those are products that we would recommend to address the freckles as well as the lentigo or lentigines. But for seborrheic keratoses, which are benign overgrowths on the top layer of the skin, those can look flesh colored, pink, light brown, dark brown. Some people may be worried because it looks like a melanoma. They can be ugly, looking like barnacles. Those can either be frozen with liquid nitrogen, if they're relatively flat, but otherwise we would numb it up and scrape them off, because they're literally overgrowths on the top layer of the skin. A lot of people call the age spots.

Nada Youssef: Sure.

Dr. Christine Lopez: Depending on what you consider age spots, there are a number of things that we can do.

Nada Youssef: So if someone has many spots on their body, many of the dark spots, like hundreds, do they get them all checked out or, which ones stand out that maybe I should go see a physician?

Dr. Christine Lopez: When you see a dermatologist, we usually do a full body skin exam where we look at everything.

Nada Youssef: Oh, okay.

Dr. Christine Lopez: Depending on what stands out, whether it's a mole, which is not just an age spot but it could be a mole or it could be a benign keratoses like I said, then we will bring that to your attention and then address them specifically.

Nada Youssef: Oh, interesting. Very good. Okay, and I have Jen. "How do I know when a mole is cancerous? Should it look a certain way?"

Dr. Christine Lopez: There are things that we look for in moles that we call the ABCDEs of melanoma. A, asymmetry. Does one half look like the other half? B, border. Are the borders fuzzy? Does it have a little notch or does it have a little protrusion? C, color. Does it have two, three shades of brown or the shades of blue, gray, red, black, white. Those are concerning. D, diameter. Greater than six millimeters, which is like the back of a pencil eraser, but I've certainly seen a melanoma that was pinpoint, Sharpie black.

Nada Youssef: Wow.

Dr. Christine Lopez: And E, which is the most important, is evolution. So, moles that change. If you have a lot of moles, and if you have a strong family history of melanoma or abnormal moles, a visit to a dermatologist is definitely recommended. That's where we look at you and we say okay, you've got a higher chance of developing cancer based on what we see, and therefore we need to see you every six months versus every year versus every two years.

Nada Youssef: I see.

Dr. Christine Lopez: We look at the ABCDEs all in collaboration. Meaning, just because it's asymmetric doesn't mean it's a melanoma. You know, we put all that into consideration. We look at all your moles and we obviously don't go out there and remove 10 of your moles.

Nada Youssef: Right.

Dr. Christine Lopez: We look at what stands out the most, which we call the Ugly Duckling mole, and we sample that and look at it under the microscope. Essentially we're triaging these and looking at it under the microscope. That's the beauty in dermatology is we're able to see what's on the surface and we can sample the skin easily enough to look at it under the microscope. Then, when we look under the microscope, they can tell us. Is it mildly atypical? Moderately atypical? Severely atypical? Or is it a melanoma, or a melanoma in situ? Then, depending on what we find under the microscope, it'll help guide how aggressive we need to be when we're looking at your moles on an annual or every six month basis.

Nada Youssef: Very interesting information. Very good. Thank you. I have another question from Cassandra. "When I go lay out in the sun, I get tan but then I get white spots on my skin."

Dr. Christine Lopez: There is a condition with many words called idiopathic guttate hypomelanosis, which is common in I'd say the 40s, 50s of different skin types. Some people will develop that, little white areas, and it's just the nature of their skin. Obviously most commonly on sun exposed areas and that's just the type of skin that you have.

Nada Youssef: So it's nothing that can go away or treated?

Dr. Christine Lopez: Correct.

Nada Youssef: Okay. Great. All right, and we have another question here. "Are there any new treatments for, I'm going to butcher this, lichens sclerosis? What are the chances of it becoming malignant?"

Dr. Christine Lopez: Lichens sclerosis is an inflammatory condition of the skin and it primarily affects the genital area. More common in women than in men, but we can also get something called extragenital lichens sclerosis where it is obviously not in the genital area. Does lichens sclerosis have a chance to become malignant? No. But the chronic inflammation that is associated with lichens sclerosis predisposes you to developing skin cancers particularly squamous cell carcinoma. So, lichens sclerosis turning into malignancy, no, but lichens sclerosis the condition can predispose you to developing skin cancer.

Nada Youssef: Interesting. Thank you. All right, and I have a question from Judy. "I am getting dark spots on my inner thighs that were never there before."

Dr. Christine Lopez: And you're probably thinking, "I don't really expose that to the sun."

Nada Youssef: Right.

Dr. Christine Lopez: Yes. Depending if it's flat or raised, if it's flat, there are these dark spots that I mentioned earlier called lentigos that can develop in areas that are not necessarily sun exposed that just develop out of nowhere. Then, if they're raised, then they can either be skin tags or benign keratoses previously mentioned. There are a number of brown spots that can happen in that area. Bring it to your dermatologist's attention so you know which one it is.

Nada Youssef: Sure.

Dr. Christine Lopez: Because there's another of things that can be ...

Nada Youssef: Sure, sure. Now, you mentioned putting on lotion daily. I know there's a lot of oils out there and there's a lot of different types of oils. Do you recommend a certain oil to use daily?

Dr. Christine Lopez: Not particularly. Again, just like with sun protection, pick one that you will like how it feels and how it smells on your skin so that it's easy enough for you to do on a daily basis.

Nada Youssef: Excellent. Great. Then I have Patti. "What is the best way to treat ingrown hairs? Should I pull them out?"

Dr. Christine Lopez: Number one, pulling them out, depending on how you pull them out, be it waxing, your fingers, tweezers, or whatever, can potentially predispose you to introducing bacteria into the skin. So I would probably err to not doing that. There are some products that we use that can help the regeneration of skin more rapidly, like tretinoin, that can help with ingrown hairs because it increases our skin turnover ...

Nada Youssef: Sure.

Dr. Christine Lopez: ... in a chemical way rather than a physically way.

Nada Youssef: Okay. Speaking of ingrown hairs, many people wax versus shaving versus threading. Is there a better way of removing hair?

Dr. Christine Lopez: Of course everyone would wish laser hair removal can take of everything, right?

Nada Youssef: Yes.

Dr. Christine Lopez: But it isn't. There are limitations to laser hair removal. Laser hair removal is only good for dark hair, light skin, but not for the peach fuzz. What would I recommend? If you were to shave, I would definitely make a habit of changing your razor or your blade more frequently than you do.

Nada Youssef: Okay.

Dr. Christine Lopez: Because shaving with a dull blade is what potentiates and aggravates the development of ingrown hairs.

Nada Youssef: So, like, weekly basis? Monthly basis? How often?

Dr. Christine Lopez: Definitely not monthly. I get my daughter disposable razors and I tell her to change them every two or three times.

Nada Youssef: Two or three, okay.

Dr. Christine Lopez: Two or three uses.

Nada Youssef: Okay, okay. Excellent.

Dr. Christine Lopez: Waxing can be highly irritating but it does work well, so I would probably recommend that. Threading I've seen work well too, so I think it's a matter of making sure that you minimize the chance of irritation if it does happen, because there's definitely a risk of burning with waxing.

Nada Youssef: Right, right.

Dr. Christine Lopez: I've seen that a lot, so be careful with that and addressing the burn immediately after, should it happen.

Nada Youssef: Excellent. Great. Well, that's all the time that we have for today.

Dr. Christine Lopez: Oh, that flew.

Nada Youssef: But before I let you go, is there anything you want to leave our viewers with that maybe we haven't talked about?

Dr. Christine Lopez: We may have talked about skin cancer but just because of the burden of that disease, skin cancer is the most common cancer compared to all cancers in combination, and it is so highly preventable by protecting your skin from the sun. Most of our sun exposure has happened before we even turn 21 or are able to drink legally, so start your sun protection earlier on because, like I said, skin cancer is such an easily preventable cancer and what best to do but to take care of our skin.

Nada Youssef: Great. Excellent. Thank you. Well, for more health tips and information, make sure you guys follow us on Facebook, Twitter, Instagram, and now we are also at Snapchat, at ClevelandClinic, one word. Thank you so much for watching.