Health Tip: Anti-Aging Strategies For Facial Skin, Part 1

If I asked you how to improve the size or shape of your muscles, you would probably say 'lifting weights,' and you'd be right. Muscles grow when they are first broken down with forceful exercise, and then they repair themselves in an effort to meet the repetitive challenge. Interestingly, the skin operates on the same principle – to see an improvement in it, you have to trigger that change with an external stimulus. Optimal skincare takes work, especially as we age.

The Big No No's
Now, before we talk about skin creams, procedures, and medications, we need to address the elephants in the room. There are some lifestyle choices that do irreparable damage to skin. Avoiding these 3 things is the foundation of youthful skin:

1. Do Not Smoke
2. Do Not Drink Alcohol in Excess
3. Do Not Get Sunburned (minimize the skin's exposure to UV radiation)

What Happens To Skin As We Age?
It's important to understand what happens to our skin as we age before we choose a strategy to restore a more youthful appearance.  The skin is made of three layers: the outermost (or surface layer) is called the epidermis, and the middle layer is called the dermis, and the deeper fatty layer is called the hypodermis. Most of the aging changes occur in the middle layer.

The dermis contains a large amount of collagen and elastin protein fibers, which give skin its elasticity.  Collagen is produced at a slower rate as we age, and can be slowed down even further by exposure to UV radiation (from the sun) or smoke (from cigarettes, cigars, etc.) The "glue" that holds the collagen and elastin together is called hyaluronic acid, and this glue is also manufactured at a slower rate as we age. The result of less hyaluronic acid is dry, scaly, and wrinkly skin – sort of like what happens to a grape when it loses its water content, it becomes a raisin.

The epidermis tends to become dry as well, with less oil production to capture moisture. The turnover rate of our skin cells slows down (by as much as 50%), causing a dull, rough skin surface. Older adults take longer to heal from wounds to the skin, and those who undergo dermabrasion may take twice as long as young adults to recover.

Skin changes in pigment cells called melanocytes result in uneven coloration. Both dark spots (the result of erratic melanocyte activity triggered by UV radiation over time) and light spots (caused by a decrease in the number of melanocytes as we age) are signs of sun damage and associated aging. Normal immune cells (called Langerhans cells) in the epidermis become more scarce over time, allowing irregular cells to grow unchecked and become cancerous.

In summary, our skin loses elasticity and moisture, slows down its natural turnover, and loses its melanocytes and immune cells over time. The result is a kind of deflation of youthful dermis, with dry, rough, discolored, and sometimes cancerous skin!

The good news is that there are many treatments available to slow this process and rejuvenate aging skin. In my next health tips, I'll discuss products and treatments that can assist with the following:

1. Removing the dry, dead layer of outer skin
2. Increasing skin cell turnover
3. Hydrating the healthy skin
4. Stimulating collagen production
5. Reducing redness
6. Reducing dark spots
7. Reducing wrinkles

References
https://www.aad.org/public/skin-hair-nails/younger-skin
http://www.mayoclinic.org/diseases-conditions/wrinkles/home/ovc-20265770
http://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/skin-care/art-20048237

If you have any questions about anti-aging strategies for skin, please log into your account and send us your question. We are here to help.

Hair Loss – How Can It Be Treated?

In my most recent health tip I discussed the possible causes of hair loss. If you have treated all the potential "reversible causes" of hair loss that are within our control (such as optimizing your medications, treating scalp infections, reducing stress, avoiding certain hairstyles or treatments, eating healthfully, and treating medical conditions that have the unwanted side effect of hair loss), then we are left with "uncontrolled" hair loss (also known as genetic, androgenic, or male/female pattern baldness)  - and the various treatments available for it.

1. Medications (there are only two FDA-approved medications for hair loss)
   
   1. Rogaine (minoxidil) for men and women. Brief summary from Mayo Clinic:  "Minoxidil is an over-the-counter liquid or foam that you rub into your scalp twice a day to grow hair and to prevent further hair loss. It may be used by men and women. With this treatment, some people experience hair regrowth, a slower rate of hair loss or both. The effect peaks at 16 weeks and you need to keep applying the medication to retain benefits."
      
      Scientists are not certain how minoxidil works to reduce hair loss, but is effective as a mild blood pressure-reducing medicine that dilates blood vessels. Perhaps the improved blood flow nourishes hair follicles and keeps them healthy longer. For women, a combination of low dose oral minoxidil (0.25 mg daily) and spironolactone (25 mg daily) has been shown to significantly improve hair growth, reduce shedding and improve hair density.
      
      Minoxidil is available as 2% and 5% solutions; the stronger preparation is more likely to irritate and may cause undesirable hair growth unintentionally on areas other than the scalp.
      
      
   2. Propecia (finasteride) for men only
      "It's taken daily in pill form. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. You need to keep taking it to retain benefits. Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer. Women who are or may be pregnant need to avoid touching crushed or broken tablets."
      
      Propecia works by blocking the breakdown of testosterone, thus allowing more to circulate in the bloodstream. Testosterone boosts hair growth.
      

Surgery
Most commonly referred to as "hair plugs," a surgeon or dermatologist removes tiny pieces of skin, each containing a few hairs, from the back or sides of the scalp and then implants the plugs into the bald sections of the scalp. Surgical procedures to treat baldness are expensive and can be painful. Possible risks include infection and scarring. Also, if balding continues, the new hairs may look misplaced (at a hairline far forward of the advancing hair loss.)

Laser Treatment
Low level laser therapy (LLLT) uses devices with diodes that emit red light (wavelength 630-670 nanometers), or infrared radiation, and are available as:

• in-salon hoods or overhead panels
• bonnet or head caps
• hand-held devices.     

To see results, laser treatments are completed two to three times a week for 12 to 26 weeks. Some salons recommend a year of treatments. There is some evidence that this therapy works by increasing blood flow to the hair follicles. However, it is a controversial therapy in the medical community and its efficacy has not been demonstrated convincingly in independent trials (in other words, mostly laser manufacturers say they work).

Wigs & Hairpieces
The final "treatment" option is simply to cover up the baldness with hair alternatives.  In cases where hair loss is due to a medical condition (like cancer), the cost of a wig may be covered by insurance.

Cosmetic Camouflages  include colored hair sprays (to cover thinning areas on the scalp), and hair bulking fibre powder.
 

References
http://www.mayoclinic.org/diseases-conditions/hair-loss/basics/treatment/con-20027666
https://www.dermnetnz.org/topics/low-dose-laser-therapy-for-hair-loss/
https://www.dermnetnz.org/topics/female-pattern-hair-loss/

If you have any questions about hair loss, please log into your account and send us your question. We are here to help.

Dr. Val Jones MD - Health Tip Content Editor

Health Tip: Hair Loss - What Causes It?

Did you know that American men spend over a billion dollars a year on hair loss treatments? Interestingly, they spend over 4 billion on hair removal products.  So getting hair where you want it, and removing it from places you don't want it, is a five billion dollar industry - and that's just what guys are spending!

A recent survey of 2000 American women suggests that they spend $80/month on hair products and treatments - which adds up to $55,000 over a lifetime. Another survey suggests that women spend up to $23,000 on hair removal products over the course of their lives.

So "hair control" is a big deal. One worthy of a few health tips, I'd say...

First of all, hair loss (from the scalp) is incredibly common. In fact, forty per cent of men have noticeable hair loss by age 35, and 80% have noticeable hair loss by age 85. This is not just a male problem, though, as the American Academy of Dermatology estimates that 40% of women have noticeable hair loss by age 40. While most people naturally shed 50-100 scalp hairs per day, thinning hair occurs when they are not replaced at the same rate.

When I think about the causes of hair loss, I categorize them into things that we can control, and things that we can't control.

Causes of hair loss that we can't control:

1. Genetics: This is by far the most common cause of hair loss. Your hair genes are inherited from your parents. Genes affect the age at which you begin to lose hair, the rate of hair loss and the extent of baldness.
2. Autoimmune disease: In some cases, our bodies attack our hair follicles, causing patches of baldness (called alopecia areata) or total baldness (called alopecia totalis).
3. Hormonal changes: Temporary hair loss may be caused by pregnancy, childbirth or the onset of menopause. Hormone levels are also affected by the thyroid gland, so thyroid problems may cause hair loss.
4. Radiation therapy: For those who require cancer treatment with radiation to the head, permanent hair loss may result.

Causes of hair loss that we CAN control:

1. Hairstyles and Hair Treatments: Hairstyles that pull hair tight, such as pigtails or cornrows, can cause hair loss from mechanical forces called "traction alopecia." Hot oil hair treatments and perms can cause inflammation of hair follicles that leads to hair loss which can be permanent.
2. Medications: Drugs used for cancer, arthritis, depression, heart problems, high blood pressure and birth control may cause hair loss. Intake of too much vitamin A may cause hair loss as well.
3. Scalp Infections: Fungal infections of the scalp (called "ring worm") can cause hair loss, but is reversible with topical antibiotics.
4. Hair Pulling Disorder: This condition, also called trichotillomania, causes people to have an irresistible urge to pull out their hair. It can be treated with psychologist or psychiatrist input.
5. Stress: Particularly stressful events can trigger hair loss and are often reversible. Sudden or excessive weight loss, a high fever, surgery, or a death in the family are examples.
6. Skin Disorders:  Conditions such as lichen planus, some types of lupus and sarcoidosis, may cause hair loss that can be prevented or reversed with medical treatment.
7. Severe Malnutrition: This may be experienced by those with anorexia from a medical or psychological condition. Healthy nutrition is important for hair growth and maintenance, though vitamin supplementation has not been shown to make much of a difference in regrowing hair.

Understanding the underlying cause of your hair loss is critical in finding the best treatment for it. Next week I will discuss all the possible treatments for hair loss, especially the kind of hair loss that we can't control by other means.

If you have any questions you'd like answered in our Health Tips email, please log into your account and send us your question. We are here to help.

References
https://www.mayoclinic.org/diseases-conditions/hair-loss/basics/definition/con-20027666

Dr. Val Jones MD - Health Tip Content Editor
Reviewed and Approved by Charles W. Smith MD, Medical Director on 8-16-2017

Health Tip: Solar Eclipse Safety

You may have heard that there will be an eclipse on August 21, 2017 and that people are planning to view it in specific cities in the U.S. On that date, the Sun, Moon, and Earth's orbits will line up such that the moon will completely cover the sun, casting a shadow on an arc from Salem, Oregon, to Charleston, South Carolina (called the "path of totality"). Observers outside this path will still see a partial solar eclipse where the moon covers part of the sun's disk.
    
I've had some questions about eye safety while watching the eclipse. To begin, I think we need to understand what is happening so we can appreciate the rationale and risks.

Do you know the difference between a lunar and a solar eclipse?
A lunar eclipse occurs when the Earth's orbit passes between the Sun and the Moon and blocks the Sun's rays from directly reaching the Moon. A solar eclipse, by contrast, occurs when the moon blocks the light of the sun from reaching the Earth, casting a shadow onto Earth. Standing in the narrow path of the shadow, the sky appears very dark as if it were night. Solar eclipses happen once every 18 months. Unlike lunar eclipses, solar eclipses only last for a few minutes. Lunar eclipses are not dangerous to look at because you are essentially staring at the Moon, not the Sun.

How exactly does an eclipse harm the eye?
Many people wrongly assume that since it is dark during the eclipse, it is safe to look up at the blocked sun. While it is true that it is safe to look at a full solar eclipse, the rays are only blocked for a few minutes, and only in the "path of totality". So first of all, if you are not in the full shadow of the moon (viewing a partial eclipse) you are exposing your eyes to direct sun rays. Secondly, if you are in the path of totality, the moon will only cover the sun fully for a few minutes - the rest of the time it will be partially covered, allowing rays to penetrate the eyes.

When excessive sun rays reach the eyes, they can cause photokeratitis, or a sunburn of the eye. The eyes will become red, and have a "foreign body sensation" (as if something is in the eye) with increased tear production and sensitive to light. If sun rays are allowed into the eyes for a longer period of time, their UV radiation can cause solar retinopathy, which results in permanent damage and possible blindness from complex chemical reactions within the rods and cones of the retina. The radiation can essentially cook the tissue in the back of the eye!

How do I protect my eyes if I want to watch a solar eclipse?
The only safe way to look directly at the uneclipsed or partially eclipsed sun is through special-purpose solar filters, such as "eclipse glasses" (available for purchase here) or hand-held solar viewers. Homemade filters or ordinary sunglasses, even very dark ones, are not safe for looking at the sun; they transmit thousands of times too much sunlight.

NASA makes the following safety recommendations:

• Always inspect your solar filter before use; if scratched or damaged, discard it. Read and follow any instructions printed on or packaged with the filter.
• Always supervise children using solar filters.
• Stand still and cover your eyes with your eclipse glasses or solar viewer before looking up at the bright sun. After looking at the sun, turn away and remove your filter - do not remove it while looking at the sun.
• Do not look at the uneclipsed or partially eclipsed sun through an unfiltered camera, telescope, binoculars, or other optical device.
• Similarly, do not look at the sun through a camera, a telescope, binoculars, or any other optical device while using your eclipse glasses or hand-held solar viewer - the concentrated solar rays will damage the filter and enter your eye(s) causing serious injury.
• Seek expert advice from an astronomer before using a solar filter with a camera, a telescope, binoculars, or any other optical device. Note that solar filters must be attached to the front of any telescope, binoculars, camera lens, or other optics.
• 
  If you are within the path of totality remove your solar filter only when the moon completely covers the sun's bright face and it suddenly gets quite dark. Experience totality, then, as soon as the bright sun begins to reappear, replace your solar viewer to look at the remaining partial phases.
• Outside the path of totality, you must always use a safe solar filter to view the sun directly.
• If you normally wear eyeglasses, keep them on. Put your eclipse glasses on over them, or hold your handheld viewer in front of them.

Full solar eclipses are an extraordinary site - just be careful that this one doesn't leave your eyes with permanent consequences!

References:

https://eclipse2017.nasa.gov/safety
https://nasa.tumblr.com/post/163907904239/counting-down-to-the-solar-eclipse-on-august-21
https://www.theatlantic.com/science/archive/2017/08/advice-for-eclipse-newbies/536010/?utm_source=atltw
http://www.visioneyeinstitute.com.au/article/dark-side-sun/

If you have any questions about solar eclipse safety, please log into your account and send us your question. We are here to help.

Dr. Val Jones MD - Health Tip Content Editor

Health Tip: What Is Plantar Fasciitis?

Plantar fasciitis is inflammation of the sheath of tissue on the bottom of the foot. It causes sharp foot and heel pain, usually worst when you first get out of bed in the morning.  It feels like walking on needles and can be very debilitating.

There is conflicting information about how to treat plantar fasciitis because different approaches work for different people.  However, I personally believe that a combination of regular stretching (calf stretches for at least 3 sets of 1 minute, 4 times a day) and avoiding exercise that exacerbates the issue (say you're a runner - you'd need to STOP running completely and switch to biking or swimming until the pain is 100% gone) is the way to go.


I don't think orthotics help much, though arch support may be helpful for those with very flat feet. It's really important to stretch frequently. If you just stretch once a day it's not enough. Most people fail stretching interventions because they don't do it daily and frequently enough. Seeing a physical therapist may also be helpful. Some people like to roll a tennis ball on the bottom of their foot as part of their stretching routine - but I've found that good old fashioned calf stretches are the best (check out the link above for instructions on how to stretch the calves).

Other things to try:

1. Boots (night splints) that keep your ankles at 90 degrees while you're sleeping (this provides a gentle stretch overnight). Some people find the boots annoying, restricting their movement and preventing sleep.
2. Anti-inflammatory medicines such as ibuprofen and naproxen - always take as directed by the drug facts label.
3. Steroid injections (in severe cases) to reduce inflammation at the heel insertion point of the fascia.
4. Avoid repetitive stress (from high impact activities such as running, CrossFit, aerobics) to the fascia until the pain is 100% gone. Then slowly reintroduce activities while continuing your stretching regimen.
5. Weight loss can help to reduce the stress on the feet, if weight is an issue.

The good news is that most cases of plantar fasciitis resolve with time. It can come back, though, so maintaining a daily stretching regimen is probably your best bet for keeping this pain away!

References

http://www.healthline.com/health/fitness-exercise/plantar-fasciitis-stretches#stretching2
http://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/home/ovc-20268392


If you have any questions about plantar fascitis, please log into your account and send us your question. We are here to help.

Dr. Val Jones MD - Health Tip Content Editor

Reviewed and Approved by Charles W. Smith MD, Medical Director on 8-2-2017