Onychomycosis or Nail disease secondary to a fungal infection (Dermatophytes, yeasts, or molds) is ver common.

It generally affects 2 to 13% of the population in North America and Europe. Common factors that favor nail infection are:

1. Occlusive Footwear

2. Increased Sweat

3. Trimming the nails more on the lateral sides of the nail (curved not straight)

4. Poor circulation

5. Diseases such as diabetes, HIV, immunosupression (being more prone to infection)

6. Humidity

The nail slowly starts to change color from a transparent pink to a whitish or yellowish color. The nail may thicken and turn powdery. There are other conditions that mimic nail onychomycosis which your physician needs to rule out with a culture, a KOH preparation (a special scraping on the nail that is checked on the microscope), and or if needed a biopsy.

After the diagnosis is done, then the correct treatment can be given. Your physician will check blood tests to check your liver and will give you a prescription for a medication that will be given for several months depending if the finger nail or toe nail is affected and will check you periodically for improvement. The toe nails grow very slowly up to 1mm per month so it will take some time for it to completely replace the nail with healthy nail. The most common drugs used are terbinafine, and itraconazole. Other drugs are being developed currently and are in Phase II and III trials.

Sometimes oral medication, which is the most effective, cannot be used for some medical or health reason and only topicals can be used. Generally only 5-8% of the patients get cured this way. Some new drugs that come in nano-particles (very small) are being developed for patients who cant take oral medication. Other treatments that can be applied are photodynamic therapy, and special lasers that when applied to the nail aid in the penetration of the antifungal drug. Currently several trials are being done to research them.

So get your nails checked and have them treated so by next spring you can use your sandals and have your nails look pretty.

Have a great week!

Dr. Welsh

IPL is a new technology that uses intense light which is filtered to treat different conditions of your skin such as acne, rosacea, solar lentigos (sun spots), broken blood vessels among other skin conditions. It is relatively painless and the cosmetic results are great. It works basically as an eraser. It erases red and brown. These procedures although pretty safe must be done by specially trained personel so as to reduce the risk of any injury or burn. So next time ask your dermatologist about these technologies.

For those of you who would love to plump your lips but haven’t decided on doing a filler, there is an alternative. Lip plumpers. These are chemicals that when applied to the skin cause vasodilation (temporary swelling) of blood vessels. Common ingredients in these plumpers are cinnamon oils and capsicum frutescens. They also have collagen microparticles and other tripeptides which enhance lip hydration. The effect generally lasts only for a few hours. Lip plumpers have become increasingly popular in recent years.

It is a common and pretty safe procedure. Only a few cases have been reported where there is skin irritation.

So if you are still thinking about getting your lips plumped with a hyaluronic acid filler and haven’t decided yet, you can get them plumped with these agents and see if you like them….

Dr. Welsh

"In an effort to clarify the role, if any, of topical retinoids in the prevention of keratinocyte carcinomas (basal cell and squamous cell carcinomas of the skin), we sought to determine whether high-dose therapy with topical tretinoin, 0.1%, could have a chemopreventive effect," write Martin A. Weinstock, MD, PhD, from VA Medical Center, Rhode Island Hospital and Brown University, Providence, and colleagues from the Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) Trial Group.

The study was halted 6 months short of the 6 year deadline due to an increased mortality in the tretinoin group vs the control group.

"We observed an association of topical tretinoin therapy with death, but we do not infer a causal association that current evidence suggests is unlikely," the study authors write. "We do not conclude that this trial provides appropriate grounds for hesitating to use topical tretinoin in clinical practice in the absence of additional evidence."

There were many limmitations to the study since the information was obtained from VA databases which might have been incompletely filled, and also commorbidities and smoking incidence were not matched equally for both groups thus failing the comparison between the groups.

"The biological implausibility, lack of specificity of causes of death, inconsistency with previous experience, weakness of other supportive evidence in our data, and weak statistical signal cast doubt on a potential causal association of topical tretinoin with death in the VATTC Trial," the study authors write.

There is no reason why to stop the use of retinoids with this limmited study.

Dr. Welsh

Hair loss is a very common condition that patients complain about at the dermatologist’s office.  Generally it is normal to loose about 100 to 150 hairs each day. The causes for hair loss are many. The most common are Telogen Effluvium, Androgenetic Alopecia (male pattern hair loss), trichotillomania (pulling out your own hair),  traction alopecia (pulling hair tightly such as pony tail hair style) and alopecia areata, but also other conditions such as anemia, thyroid disease, medical illness, medications, and different inflammations of the scalp and fungal infections can cause hair loss. That is why it is very important to see a dermatologist that can correctly diagnose the problem, order the appropriate lab work and then treat the scalp condition either with the use of shampoos, topical scalp lotions, oral vitamins that provide the essential nutrients for hair growth, and treat any medical disease that might trigger the hair loss as well .

Some general recommendations though are to wash your scalp daily, this is for oily scalps especially. Never apply hair conditioner on the scalp but on loose ends. Comb your hair when it is wet and use a wide tooth comb or hair pick. Let air into your scalp. Avoid using brushes. If you like to wear pony tail hair styles, let your hair dry first. Don’t pull your hair tightly, the looser the hair style the better.

Have a happy week.

Dr. Welsh

Here are a few recommendations if you are pregnant:

1. Use sunscreen: pregnancy hormones make pigment cells in the skin more active. Melasma is common in pregnancy so avoid the sun and use your sunscreen daily.

2. Acne in pregnancy: There are a few topical medications that can be used in pregnancy. Ask your dermatologist about them.

3. To prevent striae try not to gain more weight than what your doctor recommends and apply cocoa or shea butter daily.

4. Use compression stockings at the end of your pregnancy so you don’t get a lot of swelling and varicose veins.

5. Sometimes skin can get itchy due to increased weight gain or cholestasis in the liver. This can be relieved with some medications given by your OBGYN.

6. Enjoy your pregnancy!

And Congratulations!

Dr. Welsh

What is hyperhidrosis? It is the excesive production of sweat. This can be primary (no other disease that can cause it) or secondary (having a disease that makes you sweat a little more than normal). The most common is the primary one. The exact factors that cause it have not been identified, but a genetic predisposition has been found. Sweating is exacerbated by anxiety. It can have a deep psychologic effect. Patients with this condition sometimes have to choose clothing of certain materials and colors that will hide a little the sweating they are experiencing. What can you do about it? I recommend three steps:

1. Use an antiperspirant with micronized aluminum chloride such as Vichy7 day antiperspirant. Your dermatologist will specify how to use it. Also avoid caffeine and try to save some time during the day to cool down and relax.
2. If this doesnt help, then you can try botulinum toxin. There are many brands such as Botox, Reloxin (Dysport), and Xeomeen. They all work well. The toxin is injected to each armpit and the sweating virtually stops or decreases significantly for a few months. Anywhere from 4-9 months. In average, it lasts around 6 months.
3. Then there is surgery. There are two basic surgeries. The one with the least side effects is Sweat gland suction. The sweat glands are suctioned like in a liposuction surgery. It is pretty non invasive, but it can cause skin scars. The other one is ETS where the nerves that make you sweat are basically cut off. You can get compensatory sweating among other side effects.

Other procedures such as iontophoresis are pretty time consuming.

Happy Holidays,

Dr. Welsh

Now a days it is very common to go to a tanning parlor to get some skin color. It is important to know that tanning the skin although it may look attractive, it is a response to celular damage. The production of color has the purpose to protect from further damage. So whenever you see someone very tanned, remember that what it really means is that their skin is REALLY hurt or damaged by the sun. Now, it is also known and has been reported that sun tanning can become an addiction. Yes, an addiction. When someone gets a sun tan, the human body produces endorphins which are the “make me feel good” substances. So for some people it is hard to beat the habbit. There is a solution though, you can get sunless tanning using many different creams that can add some color to the skin. So next time you think about getting a tan, get a safe SUNLESS tan.

Have a nice week,

Dr. Welsh

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There are a few tips you should know when buying makeup such as foundation…
1. If you have oily skin: buy oil free foundations from Prescriptives or Clinique
2. If you have very sensitive skin, you can try Almay products although no makeup is 100% proof that you won’t have a skin allergy.
3. If you have melasma (brown blotches on your cheeks), try using covering make up such as Dermablend. You can find them in Department stores such as Dillard’s, Macy’s…
4. If you have acne, try to stick to no makeup or, oil free makeup. There are some brands such as Neutrogena that have salycilic acid which in turn helps reduce acne a little.
5. If you tend to get sun spots or you hate to reapply sunblock during the day over makeup, there are some makeup powders that have sunscreen. Brands such as Philosophy and Color Science are some examples….

Have a nice week,

Dr. Welsh