Water’s Edge Dermatology providing skin cancer  and sunscreen awareness to UPS drivers.

Vitamin D supplementation has been a recent media topic as well as a frequent question posed by our patients. Why the sudden hysteria? Actually, the vitamin D controversy is nearly 100 years old. It began in the 1920’s, around the same time period as the Coco Chanel’s trendy “tanned is beautiful” message. People who were tan were perceived to look healthier. This ultimately led to the public opinion that sun exposure was beneficial to health. This belief was further reinforced by the discovery of vitamin D being the active component in cod liver and shown to prevent childhood rickets as well as UV radiation causing vitamin D synthesis.

Despite the suspicion of UV radiation as a human carcinogen existing in medical literature as far back as the 1890’s the quest for tan began. There is now overwhelming evidence that UV radiation is carcinogenic. Melanoma and Non-melanoma skin cancers have continued to increase at dramatic rates characterizing these cancers as nearly epidemic. Despite the overwhelming evidence of the development of these cancers, the political crusade of some to promote unprotected UV exposure in order to increase ones photosynthesis of vitamin D in the skin still continues.

The question here is not in the benefit of adequate serum vitamin D levels, but more so in the ways to obtain these levels. Experts from the American Academy of Dermatology have examined the research and report evidence suggesting adequate vitamin D levels can be obtained through dietary consumption or supplementation equally and interchangeably as metabolizing it cutaneously from unprotected sun exposure.

Please take the time to review the recent article of Vitamin D from the Mayo Clinic.

http://www.mayoclinic.com/health/vitamin-d/NS_patient-vitamind

Vitamin D Fact Sheet Provided by National Institute of Health

What is vitamin D and what does it do?

Vitamin D is a nutrient that helps almost every part of the body. Like calcium, it builds bones and teeth and keeps them strong.

How much vitamin D do I need?

It depends on your age. Here are the amounts people of different ages should get on average each day, listed in International Units (IU):

Birth to 12 months
400 IU
Children 1–13 years
600 IU
Teens 14–18 years
600 IU
Adults 19–70 years
600 IU
Adults 71 years and older
800 IU
Pregnant and breastfeeding teens and women
600 IU

What foods provide vitamin D?
Only a few foods naturally have vitamin D. The best source is fatty fish like salmon, tuna, and mackerel. Beef liver, cheese, egg yolks, and mushrooms provide smaller amounts. You might be able to get recommended amounts of vitamin D by eating a variety of foods with plenty of fortified milk and fatty fish.
Almost all milk in the United States is fortified with 400 IU of vitamin D per quart. Vitamin D is also added to some breakfast cereals and brands of orange juice, yogurt, margarine, and soy beverages (check the product labels).

Can I get vitamin D from the sun?

The skin makes vitamin D when exposed to sunlight. But when out in the sun for more than a few minutes, wear protective clothing and use sunscreen (with an SPF of 8 or more) to lower the risk of skin cancer.
If you avoid the sun or cover your body with sunscreen or clothing, make sure you get enough vitamin D from food or take a supplement. When you’re indoors, sunlight on your skin coming through window glass is not strong enough to make vitamin D.

What kinds of vitamin D dietary supplements are available?

There are two forms: D2 and D3. Both raise vitamin D levels in the body.

Am I getting enough vitamin D?
People with dark skin, older adults, obese people, and people with some digestive disorders (like Crohn’s disease or celiac disease) may not get enough vitamin D unless they make a special effort. Breastfed infants should be given a vitamin D supplement of 400 IU each day.
Vitamin D can be measured in the blood to learn whether your levels are too low, too high, or somewhere in between. It’s not yet clear what levels of vitamin D in the blood are best for good health.

What happens if I don’t get enough vitamin D?

Vitamin D deficiency causes rickets in children, where the bones become soft and bend. It is rare but sometimes occurs, especially in African American infants and children. In adults, vitamin D deficiency causes bone pain and muscle weakness. Adults who don’t get enough vitamin D and calcium can develop weak and brittle bones (osteoporosis).

What are some important links between vitamin D and health?

Scientists are studying vitamin D to see how it affects health. Here are a few examples of what this research has shown.
Bone problems
As they get older, men and women can develop weak and fragile bones, a condition called osteoporosis. Supplements of both vitamin D and calcium can reduce the risk of bone loss and fractures in elderly people. Talk with your healthcare provider about vitamin D and calcium as part of a plan to prevent or treat osteoporosis as you age.
Cancer
Some studies have tried to find out whether getting more vitamin D can affect the chances of developing cancers of the colon, breast, prostate, pancreas, and other parts of the body. It’s too early to say whether low levels of vitamin D affect one’s risk of cancer.

Can vitamin D be harmful?

In healthy adults, and in pregnant and breastfeeding teens and women, vitamin D at doses up to 4,000 IU is safe. (The safe amount is 1,000 IU for infants in the first six months of life and goes up as you get older to 4,000 IU in children age 9-13 years.) When taken as a supplement at very high doses, vitamin D can cause nausea and vomiting, confusion, and serious heart problems. Vitamin D made in the body from sunlight does not rise to dangerous levels.

Does vitamin D interact with any medicines or dietary supplements?

Yes. For example, prednisone and some medicines taken to lose weight, lower cholesterol, or control epileptic seizures can raise the need for vitamin D.
Bottom line: Tell your doctor, pharmacist, and other health care providers about any dietary supplements and medicines you take. They can tell you if those dietary supplements might interact or interfere with your prescription or over-the-counter medicines or if the medicines might affect how your body uses vitamin D.

Where can I find out more about vitamin D?
Office of Dietary Supplements Health Professional Fact Sheet on Vitamin D

Office of Dietary Supplements Consumer Fact Sheet on Vitamin D

Vitamin D Content of Selected Foods Per Common Measure

For advice on buying dietary supplements, see the Office of Dietary Supplements Frequently Asked Questions

For information on the government’s food guidance system, see MyPyramid and the Dietary Guidelines for Americans

Disclaimer
This fact sheet by the Office of Dietary Supplements provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health.

http://ods.od.nih.gov/factsheets/VitaminD-QuickFacts

Psoriasis is a chronic autoimmune disease that appears on the skin. It happens when skin cells quickly rise from below the surface of the skin and pile up before they have a chance to mature.

The good news is that people don’t have to let psoriasis affect their quality of life. At Water’s Edge Dermatology, our practitioners are trained and experienced in treating psoriasis. We all have experience in treating this chronic condition. While there’s no cure yet, there’s plenty we can do together to make the psoriasis patient’s quality of life more manageable.

If you are suffering from psoriasis, it’s important to know that you’re not alone. As many as 7.5 million Americans deal with the challenges of psoriasis. With today’s treatments, you can live the life you want. Evolving treatments can improve the symptoms of psoriasis or even send them into remission. With patience and persistence, psoriasis patients can get back the life they want.

One question patients always seem to ask is “How severe is my psoriasis?” One way to measure the severity is how much of the body is covered. Mild is less than 3% of the body is covered. Moderate is 3% to 10% and Severe is more than 10%. A patch of psoriasis the size of the palm of your hand is equal to about 1% of your body surface.

Psoriasis often appears between the ages of 15 and 35, but can affect people of all ages and races, men and women equally. After treatment, it will often clear up for months, only to start again. Up to 30% of those with psoriasis also eventually develop psoriatic arthritis, which causes stiffness and swelling in and around the joints.

Putting together a successful treatment plan for the psoriasis patient depends on several factors. First, your practitioner will consider the amount of your body surface covered by the disease. But even more important is the severity of the patient’s symptoms and how they affect the quality of life.

How the patient feels about having the disease is very personal. One person may not be troubled by patches of psoriasis that can be kept covered. Someone else who has small patches on an area clearly visible may feel very embarrassed and want to try a more aggressive treatment.

Psoriasis is a non-contagious common      Guttate Psoriais looks like small
skin condition that causes rapid skin         salmon-pink drops on the skin.
cell reproduction resulting, in red, dry
patches of thickened skin.

At Water’s Edge Dermatology, our practitioners work with patients to determine what the patient wants from treatment, how long the patient has had the disease and what treatments have already been tried. This information is factored into the patient’s lifestyle, overall health and severity of symptoms. The most important factor in treatment is to follow the treatment plan that is developed exactly.

Treatment is dependant on the severity of the disease. Topical drugs may be used in mild to moderate cases of psoriasis. These topical drugs may be medicated lotions, ointments, creams, gels or shampoos. Most require a prescription.

Phototherapy uses ultraviolet light to treat moderate to severe psoriasis. There are three types of phototherapy. Ultraviolet B (UVB) – The patient’s skin is exposed to UVB rays generated from a special lamp or laser. The exposure causes reactions in skin cells that decrease their overproduction and help clear up plaques. Psoralen and Ultraviolet A (PUVA) – The patient ingests, applies topically or bathes in a drug called psoralen, then undergoes UVA exposure. The combination of the drug and the ultraviolet light slows skin cell growth. Excimer laser – A controlled beam of UVB light targets only affected areas, reducing inflammation and fast-growing skin cells. This treatment is appropriate for patients with very localized, mild disease. Body-wide medications – Moderate or severe psoriasis that has resisted other types of treatment may be treated with medications that treat your entire system. These medications may be taken orally, injected or infused by IV. They include Acitretin, Cyclosporine, Methotrexate, Alefacept, Adalimumab, Etanercept, Golimumab, Infliximab and Ustekinumab.

Psoriasis of the scalp may have fine,        Psoriasis may only involves the nails.
dry, scaly skin or have heavily
crusted plaque areas.

Alternative approaches include sun and water therapy – short exposure to daily sunlight and the addition of water-ocean, hot springs or hot tub-helps soften plaques. Meditation can encourage an improved immune system response. Yoga teaches meditation and controlled breathing, which reduce stress (a common trigger). Nonprescription topical treatments, including aloe vera, evening primrose oil and capscaicin have all proven effective in clinical trials.

Medical treatment will go a long way toward helping the psoriasis patient control the disease. Making lifestyle changes can also be helpful in easing skin discomfort and minimizing periodic flare-ups. Adequate sleep, eating a balanced diet, regular physical exercise and drinking plenty of water will keep stress levels down and the body in top condition to fight off infection.

Diseases of the skin, like psoriasis, are reasons why everyone should have an annual skin examination by a dermatologist. At Water’s Edge Dermatology, our practitioners are highly experienced in psoriasis and all diseases of the skin. If you have any questions about psoriasis or other questions relating to skin care, Email them to me below. And if you haven’t had a skin examination in the past year, call one of our convenient locations for an appointment.

According to the American Cancer Society, more than a million Americans will
be diagnosed with skin cancer this year. In Florida, skin cancer is more common
because of the intensity of the sun. In my dermatology practice, I have noted
the increased number of patients that we are seeing with skin cancer. That’s not
surprising when you understand the risk factors for skin cancer.

Exposure to UV radiation that comes from the sun, sun lamps, tanning beds or tanning booths is a primary risk factor. A person’s risk of skin cancer is related to lifetime exposure to UV radiation. Most skin cancer appears after age 50, but the sun damages the skin from an early age. UV radiation affects everyone. That’s why an annual skin exam is so important.

The two most common types of skin cancer are basal cell cancer and squamous
cell cancer. They usually form on the head, face, neck, hands and arms. But skin
cancer can occur anywhere. Basal cell skin cancer grows slowly. Squamous cell
skin cancer sometimes spreads to lymph nodes and organs inside the body. The
third form of skin cancer, Melanoma, is generally the most serious form of skin cancer because it tends to spread (metastasize) throughout the body quickly.

The most common warning sign of skin cancer is a change in the appearance
of the skin, such as a new growth or a sore that will not heal. Unexplained
changes in the appearance of the skin lasting longer than two weeks should be
evaluated by an experienced dermatologist. According to the National Cancer
Institute, the cure rate for basal cell and squamous cell cancers could be 100%
if they were brought to a dermatologist’s attention before they had a chance
to spread. Because cumulative sun exposure is a primary risk factor, it’s very
important for all of us to have an annual skin cancer exam. In that manner, we can compare changes in the patient’s skin, from year-to-year.

A change on the skin is the most common sign of skin
cancer. It may be a new growth, a sore that won’t heal, or
a change in an old growth. Skin changes to watch for include:

A small, smooth, shiny, pale or waxy
lump is a common sign of skin cancer

A firm, red lump is another sign of skin cancer

A sore or lump that bleeds or develops
a crust or scab is another sign

A flat red spot that is rough, dry, or scaly
and may become itchy and tender may be skin cancer

A red or brown patch that is rough
and scaly may be skin cancer

Checking your skin for new growths or changes is a good idea. You
should report any changes to your dermatologist right away.

Often, the frst sign of melanoma is a change in the size, shape color or feel of an existing mole. Melanoma may also appear as a new mole. It may be black, or “ugly looking.”

Don’t use photos to try to diagnose your own skin cancer. They can’t
take the place of a dermatologist’s examination.

Here are some pictures of what melanoma can look like:

The shape of one half does
not match the other. It’s asymmetric.

The borders are ragged, notched, blurred or irregular.

The color is uneven. Shades of black,
brown and tan may be present.

There is a change in size, usually an increase.

If you haven’t made an appointment for your summer-ending skin cancer exam, now is the time. Skin cancer is the most common form of cancer. The earlier it is diagnosed, the better the chance for cure.