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Originally posted: Feb 28, 2022 fried potato chips and warm fire You have probably heard by now that what you put into your body impacts your health. But for some reason most people don’t think the same is true for their skin. Do you have eczema? Skin rashes? Do you know someone who does? You might find it helpful to know that elimination diets don't necessarily improve eczema and may cause harm if not done the right way! But in some cases, people do experience benefit, especially when done in conjunction with a nutrition expert . This can be invaluable. Food allergy may be a predictor of risk for eczema and sometimes eczema and food allergies go together. One does not necessarily cause the other. BUT, it is completely possible to notice a worsening of skin when eating certain foods, even when food allergy testing is negative. Eczema is really complicated. And so are our bodies. I have often told my patients to keep a food diary like this one, but sometimes they want to know where to even start if they are on the hunt for their triggers. Do they have to give up their favorites? And can they even afford to make substitutions? Food is sacred to us. It reflects how we experience life. In many ways it is life. Family traditions, holidays, celebrations, festivals, gatherings center on food. The truth is, you don't have to give it all up. You just have to be smart about it. Learn what was helpful to others who suffer from eczema and see if it might also be helpful to you. Success leaves clues, as they say. Over the last few years we have better data, some of it compiled by people who actually have eczema on what the most common triggering foods are. I lament that in the clinic, this information makes it only to the ears of my patient. But here I am writing it out now for all of you. Let’s just get right to it! First, limit your intake of SALT. This alone may be particularly important. An article  was published which revealed responses to a survey of 169 people with eczema, asking what made their skin worse and what foods they avoided in an attempt to make things better. Their responses are here just for you! Junk Food It's no surprise that junk foods make the list. These foods are often cooked in highly processed oils and syrups and have ingredients no one can pronounce. They line the pockets of the food giants and steal our health. Many people who struggle financially, deal with food insecurity and live in "food deserts" may feel they have limited options for better nutrition. They may feel junk food is all they can afford. But unfortunately the cost of eczema is huge (some studies  suggest at least $600 a year), when you factor in costs of creams, moisturizers, medications, not to mention the unseen costs of lost sleep, depression, poor quality of life, etc. Junk foods are deceiving because though might seem cheap on face value, they certainly have innumerable downstream costs, including worsening of overall health. Adding more whole foods to a diet can be done in an affordable way. Look to add in nourishing and filling foods such as beans and lentils. If you're in a position to take aim at food insecurity, check this  out. Eggs Eggs also made the list, which is not surprising. Egg allergy itself is not uncommon, and it has been strongly associated with atopic dermatitis flares for almost one hundred years. If your atopic dermatitis is flaring, look for ways eggs may be sneaking into your diet (think baked goods) and see whether there is any correlation. But you can still find many beautiful ways to enjoy them! These were from our egg hunt last spring, I think! the decorating was the very best part! Dairy Cow's milk is another common allergen which in some people may trigger flares of their atopic dermatitis. This is probably due to the cow's milk protein. Fortunately, cow's milk can easily be substituted for a plant based milk which can be so delicious. Have you checked out this site  for ideas? Just be sure to speak with your dermatologist or primary doctor about it and never ever substitute it in your baby or child without speaking to your child's physician. This can actually be dangerous! But in adults, it's usually an easy transition if you have the right tools! Gluten Many people in the study found gluten to be a common trigger. Though thankfully gluten intake does not seem to be a risk factor  for atopic dermatitis/eczema, observational studies have linked atopic dermatitis to celiac disease, which is a serious autoimmune condition where people cannot safely eat gluten. Once again, there are many substitutes for gluten now that people are more aware of inflammatory foods. (And don't judge the appearance of my strawberry rhubarb cake because it was actually quite delicious). Nightshades Sadly some of my very favorite foods made the list of common triggers. But don't throw the baby out with the bathwater! Nightshades are a family of plants that include tomatoes, potatoes, eggplant, etc. Many of these plants have excellent nutritional benefits, but some have chemical compounds that are frankly carcinogenic. For instance, tobacco is also a nightshade. tobacco, credit wix Nightshades contain alkaloids which may have a medicinal or biological impact on the body. The alkaloid content may increase at times (eg when a potato turns green and sprouts). If my patients suspect they have an allergy to nightshades, I often recommend that food journal to see which of the many plants in this category may be the culprit. Alcohol, sugar, and citrus were also reported triggers, as you can see here. What are some other important things we can do when we have eczema? Avoid chemicals in our cleaning products and personal care products! Give your laundry an extra rinse and skip the fragranced fabric softener. Wear gloves when cleaning and change them often! Replace caustic and toxic compounds with more natural cleaning agents like this one . Wash your hands immediately after and then apply a moisturizer. MOISTURIZE your skin at least once daily with an affordable, fragrance-free product such as shea butter or Vaseline (not just any old petrolatum). Do this immediately after getting out of the bath or shower and patting the skin dry. Think of it as sealing in the water and repairing your skin barrier. Avoid harsh antibacterial soaps when possible which can strip the skin and cause breakdown of the delicate skin barrier. Use lukewarm water in the shower or bath. I live up in the Northeast where the winters can be frigid, and a long hot shower can be tempting. But try to turn down the heat and keep it to just a few minutes. If you can tolerate, try making the last bit of the shower a cold one. Add a humidifier to the bedroom if you can. These can be affordable because both the cool mist  ones and the warm mist ones work at forcing moisture into the air, and the cool mist humidifiers are available in many pharmacies, supermarkets and drug stores. Just make sure to clean the filter often. Paul Farmer once wrote, “Understanding more about the causes of the causes will help make medicine matter, help make it better, in part because it forces us to be better listeners.” Though these reports of people's real world experiences with eczema certainly don't give us all the answers, they give us invaluable information still. I have personally found that listening to my patients gives me some of the best clues to help them figure out how to get better. And I think I get better that way too. Many thanks to Dr. Paul Farmer for a legacy of inspiration, hope, dedication and courage. 1959-2022

Originally written: May 5, 2022 If you read the news these days, things can get you down. There is so much turmoil, sickness and sadness. It breaks many a heart. I am sad to say that what is ALSO troublesome these days is the continued burden of preventable skin cancer. In the US, it is estimated that 95% of skin cancers are due to modifiable risk factors. That means, if we were better at getting the information out, if we were better at targeting these risk factors, fewer people would suffer. I'd like to keep getting better. Prevention is the word of the year. According to cancer.net ,   it is estimated that almost 100,000 adults in the US will be diagnosed with melanoma in 2022. Thousands will die from this condition unless we can change our ways. Thousands of Americans also may die of the more common, but less aggressive squamous cell carcinoma this year. So what do we do? Dermatologists recommend a tiered approach. Of course, sun/UV protection is the first line of protection. Start early. I remember reading a study once that indicated that most people get the majority of their sun exposure in childhood. Learn how to better protect yourself and your kids. We all need to get outside, breathe fresh air, explore our wonderful planet, but do it with sun protection. We know that one of the most preventable and highest risk factors for skin cancer is exposure to ultraviolet light, whether on the beach or in a tanning bed. Play in the shade! Look for shade structures  when outside. Incorporate them into your outdoor spaces and plan activities when the intensity of UV isn't at its peak. Shade seeking and clothing leads to   fewer sunburns   compared to sunscreen. According to Cancer Research UK, getting a sunburn just once every two years can TRIPLE risk of developing a melanomaUse sun protective clothing and hats.I love this  one. And this.   Use physical non-micronized sunblocks for areas that can't be covered. I use this  on my kids and I just love the scent. Stay away from the tanning beds. Every time you step into the tanning bed you increase your risk for skin cancer. Just say no. As of 2022, tanning is illegal for minors in 23 states due to the known risk factors for skin cancer. Intense INTERMITTENT exposure seems to be particularly dangerous. Be careful with change of seasons and WHEN ON VACATION! Don't forget protection for your eyes. Yellow/orange filters are thought to be superior to other lenses in your sunglasses. How cool are these ! My little guy could probably loan you a pair of his... sun protection But what about Vitamin D? Many people think that they need to spend quite a bit of time in the sun in order make Vitamin D. But actually, this isn't really the case. Photo by Zach Vessels on Unsplash For instance, even at the very northern latitude of Oslo, Norway, studies suggest that just 30 minutes fully in the summer sun will make 10,000-20,000 IU of Vitamin D. That is WAY beyond the necessary recommended daily allowance, and often lower than the threshold where many will get a sunburn. My rule of thumb I share with my patients is that generally speaking, for fair skin populations, “10 minutes a day, 10 percent (skin) exposure” is generally sufficient to make your Vitamin D. Now if you have darker skin, you may need a few extra minutes. More melanin means it takes a little longer to synthesize Vitamin D. Similarly, if you are older than 50, you may also need a few extra minutes. This is because over time we have less dehydrocholesterol in the top layer of our skin. This is one of the compounds that starts the process. I generally recommend that my adult patients take the RDA of Vitamin D, which is 600IU. They even have them in gummies ! Supplements and Medications What about other measures? Are there other things we can take to reduce our risk of skin cancer? This is complicated, and we don't have all the information yet. But to make a long story short, the answer is probably so. There is some evidence that eating a healthy diet rich in naturally occurring compounds may be helpful as part of an overall risk reduction strategy. Antioxidants (which target DNA damage from dangerous reactive oxygen species) that occur NATURALLY in plant foods may play a role. But (and this is a big but) this may not necessarily be true for supplements, where the data is controversial and even at times, concerning. Similarly, high citrus consumption  even in natural forms prior to high outdoor exposure may prove to be dangerous! It may be sensitizing to the dangerous UV effects! For people who have made at least one skin cancer, most importantly squamous cell carcinoma, who have a fair amount of sun damage, I encourage them to speak to their doctors about NIACINAMIDE (also known as nicotinamide). I do not recommend this for everyone. However. it is essentially a form of Vitamin B3 that has been studied extensively as part of an overall risk reduction strategy. It is not recommended for lower risk populations, but again for high risk populations, this may be helpful. Definitely, speak with your health care providers about this! Niacinamide Interferes with carcinogenesis by augmenting DNA repair Inhibits inflammation in irradiated keratinocytes Restores the skin barrier Effects diminish after six months post intervention. Usually prescribed as 500 mg by mouth twice daily. For people who have had a solid organ transplant and a skin cancer, you may also want to speak with your physicians about a medication known as acitretin. This has some more side effects but for people with solid organ transplants who are at high risk for skin cancer, it is definitely worth the conversation with your doctor! Also, if you are a person who has had precancers and you have been treated with that liquid nitrogen spray to destroy them, speak with your doctor about field treatments to see whether you are a candidate. These come in a few forms, but generally the most commonly used is a topical prescription medication. Some medications for other conditions may increase risk for skin cancer. If you are on medications for an organ transplant, high blood pressure, high cholesterol or other conditions, AND YOU ARE HIGH RISK for skin cancer, ask your health care provider whether there are alternatives that might be safer. Many times, the answer is yes. Screening and Education I recommend a periodic skin cancer screening for every adult in the US. To clarify, of course this does NOT have to be done by a board certified dermatologist! But it should be done by your physician or health care provider from time to time, more often of course if you are higher risk. More importantly, for my patients with multiple moles, I always recommend GETTING TO KNOW YOUR MOLES AND BIRTHMARKS! For some people, who have very few, this might not take much time. However, for my patients with 20 or more moles, I generally recommend that they look at their moles at least once a month. That way, if something changes, they know right away! This is critical since we know that the faster you detect a skin cancer, the better your overall chances of survival and decreased morbidity. Don't know how to do this? Take a smartphone photo! Use this as your baseline, and repeat as needed. We also need to start screening and education early. Skin cancer often shows up later in life, but the damage that often leads to it many times happens very early in life. If we educate our kids on the risks, and keep REMINDING them, we stand a better chance. Skin of Color skin of color still at risk for skin cancer What about if you have skin of color? Are you still at risk for skin cancer? The answer is a definite YES! Skin comes in many beautiful shades. Some are more predisposed to skin cancer from UV rays. Some have a little more protection from that form. However, the sad truth about skin cancer is that not all skin cancers are sun induced. Many happen from other alterations in DNA that were not caused by UV, but by other factors, such as genetic risks or other pathways. Also, when people THINK of a sunburn, they often imagine bright red or blistering skin. But people with darker skin may not experience a sunburn that way. It may just be tingling or irritated skin. But the damage is still happening. So yes, even if you have skin of color, get to know your skin, and pay attention to anything changing or evolving. Pay particular attention to the palms, soles and nail beds which are occasionally the sites of melanoma in people with darker skin. These are only a few of the steps we can take to reduce our risks. My hope is that with more information, we can reduce these risks and the burden of skin cancer over time. It's my mission. invest in a better future. Photo by Larm Rmah on Unsplash So what can you do? Take Action!  Invest in sun protection, and make it a habit. Advocate for safe outdoor spaces for kids in your community. Your school can apply for a grant for a shade structure through the American Academy of Dermatology. Learn more about it here. Find sun protective clothing, hats and sun block that you like and you will wear. If you have one, go put it by the front door now so it will be ready for you the next sunny day you head outside. Ask your doctor if you are a candidate for niacinamide. If you have an organ transplant and you have already had a skin cancer, ask your doctor about acitretin. If you are on medications and you have a high risk for skin cancer, speak with your health care provider about risk benefit and alternatives if available. Go take a good look at your skin! Repeat this periodically. Get to know your skin so that if it ever changes, you are more likely to catch the change right away. This is how we do it. Let's do it together. My very best to you... Take care reader.

Originally written Feb 21, 2022 One of the most beautiful gifts a mother can give her child is attachment. It fosters a feeling of security. It says to your child, "You are not alone in this world". It outlasts physical presence. As a dermatologist with a focus on the skin, I have long known of the medical benefits of skin to skin contact in the newborn period. As a mom, I have lived them. skin to skin with newborn Many of the exceptional benefits of skin to skin contact in the first hour of life were enumerated in an article by research scientists Widstrom et al.   We know that immediate skin to skin contact has advantages for both mom and baby in that critical time after birth. Some of these benefits include Reduced bleeding in mom Earlier delivery of the placenta Ease of breast feeding Lowered maternal stress Lower stress in baby. In fact, the WHO (World Health Organization) included skin to skin contact in their recommendations for the most successful steps for breastfeeding. But sadly, perplexingly, astonishingly, it's been slow to catch on. Maybe it's because the seemingly simple things are first to get overlooked. Or maybe it's because people don't understand the science of it all. So here we go. In the period immediately after birth, mom's oxytocin level is extremely high. Oxytocin is known as the maternal hormone. mom and babe, wix credit Oxytocin serves many purposes. It contacts the uterus to stop bleeding. It seems to develop the "maternal instinct", the sense that mother uses to protect her young. It is thought that it contributes to a mom's desire to keep her babies close after birth , and is enhanced by a baby's suckling or even a simple touch of her nipple in the first hour of birth. Its effects continue. They enhance a mother's senses, and protect her infant. Oxytocin is released by both mother and baby after suckling. This stimulates the release  of gastrointestinal hormones (SSK and gastrin) that lead to better sleep after baby nurses, and everyone knows a new mama and her baby need sleep. Oxytocin (released in part by skin to skin) helps with the arrival of colostrum. In the first 24 hours of life, the scent of this early milk increases the amount of oxygenated blood cells in the part of the brain that is associated with scent , helping baby to recognize and remember the scent of his mama. According to Widstrom ,  being skin to skin with mom after birth helps babies to go through what are considered the nine instinctive stages: birth cry, relaxation, awakening, activity, rest, crawling, familiarization, suckling and sleeping. It is thought that these help a new baby to learn how to self regulate , something she can carry with her throughout her life. They also help develop a baby's five senses! Immediately after birth, baby's catecholamines (hormone neurotransmitters) are exceptionally high ( 20 X higher  than those of a resting adult). This has been labeled “good stress”. When baby is placed skin to skin, these catecholamine good stresses help strengthen memory, and bond between mom and baby grows stronger. The body has evolved remarkable ways to connect mom and her baby. In the immediate period of birth, when baby roots for the nipple, and eyesight is just developing, baby is aided by the fact that the skin has darkened around the nipple. Babies see contrast, and this darkening of the nipple skin illuminates the path to invaluable colostrum, full of antibodies from mom. When babies are placed skin to skin after birth, researchers believe that babies blood sugar  levels are optimized, which can reduce the risk of adverse events in that delicate neonatal period. Widstrom  describes that during those nine instinctive stages that happen when skin to skin is embraced, a baby will search for eye contact with mother within the first hour, eyes that baby has not yet seen but who belong to a person she already knows well. Let’s face it; skin to skin is crucial. It is not just for the birth mother-baby dyad, but helpful also when others  are able to safely to perform skin to skin. It's a family affair! I loved this guide on safe interactive skin to skin. Good luck new parents. You've got this. Take care reader.