skin health

How do I know if a mole is skin cancer?

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uptodate.com

Over the past year or two, I’ve noticed two moles have come up around my hip area. Should I be worried? Could this possibly be a symptom of skin cancer? Can I get tested for that on campus?

We’ve covered skin cancer from a few angles.  How to use sunscreen correctly to prevent skin cancer.   How the incidence of melanoma – the worst kind of skin cancer – from UV light exposure has increased dramatically over the last three decades, particularly in young women.  Even whether spray tanning is a safer alternative.  But we’ve never talked about what to do when you have a mole that’s bothering you.

In this situation, a picture really is worth a thousand words.  Click on the photo to the right for an excellent visual guide and remember your ABC’s when it comes to figuring out if a mole is worrisome.  Moles that are skin cancer tend to:

Asymmetry – have one half that looks different than the other half

Border – have a jagged or uneven edge

Color – have different colors

Diameter – be larger than the eraser on the end of a pencil (about 6mm)

Evolution – change shape or color over time

Many moles and birthmarks are totally normal, even if they meet some of these criteria, but as a dermatologist once told me in med school – nobody has microscopic vision and the only way to tell for sure if a mole is abnormal is to look at it under the microscope. 

This is called a skin biopsy, and to answer your 2nd question, yes you can get tested for that on campus.  In fact, we can do skin biopsies right here at the Student Health Center and send the tissue sample over to the pathologists at the medical center to analyze.  We also have a great network of dermatologists here in town that we can refer you to if a mole is really large or in a cosmetically important area like the face. 

If you have any concerns at all about a mole, come in and see us.  We are more than willing and able to help you decide if it is something to be worried about, and we can get you the treatment you need if it is.

John A. Vaughn, MD
Student Health Services
The Ohio State University

My doctor said that my vitamin D level is low. Is that really bad?

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webmd.com

It’s well established that Vitamin D is important in the regulation of the body’s calcium levels and bone development.  If people don’t get enough, they are at risk of diseases like rickets and osteoporosis.  But researchers have more recently discovered that vitamin D receptors are found on almost all tissues of the body.  This has caused a “boom” in vitamin D research; scientists are investigating its role in everything from heart disease and diabetes to depression, cancer and the common cold. 

You get Vitamin D in two ways: by consuming it in foods or supplements, and by making it in your skin when sunlight hits it.  Vitamin D doesn’t occur naturally in a lot of foods – unless you’re a really big fan of cod liver oil or mackerel, you wouldn’t get nearly enough – so many foods are fortified with it.  Almost all of the milk sold in the U.S. is fortified with Vitamin D, as are many cereals, juices and yogurts. 

This time of year in Columbus ain’t exactly the most Vitamin D friendly environment – the sun seems to head south for the winter – so it’s not unusual for people around here to have a low Vitamin D level.  But what does that really mean?  How low is too low?  And does having a low Vitamin D level increase your risk for depression, high blood pressure, the flu?  We don’t know for sure.  There’s even a lot of debate going on right now about whether or not the current cut off for a “normal” Vitamin D level is too high and that a lot of people are being told they have a deficiency when they really don’t. 

That being said, people build up the majority of their bone density during their twenties so it wouldn’t hurt to take a daily adult multi-vitamin containing around 600 IU of Vitamin D to help prevent osteoporosis later in life.  It’s also a good idea to get some regular sunlight exposure whenever you can; even if it’s cold, it’ll turn on your skin’s Vitamin D factory.  But don’t overdo it – taking too much (over 4000 IU) can cause damage to the heart, blood vessels and kidneys.  And excessive uv radiation exposure can damage your skin and put you at risk for really bad things.   

The National Institutes of Health has a great site about Vitamin D supplements, and the Mayo Clinic also provides a lot of good information.  And of course, you can always make an appointment to see us if you’re worried about your Vitamin D level.   

John A. Vaughn, MD
Student Health Services
The Ohio State University

More questions about warts – the gift that keeps on giving!

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common wart

We’ve received a couple of follow up questions from a BuckMD reader on our last post about warts, and clearly this individual has excellent taste in writing:

Thanks for another great article. I like your writing style.  It almost sounds like the warts are more infectious after treatment than before. Is that true?

Also, one more follow-up question if you don’t mind: when the warts are removed, is the HPV virus still present in the body, or does it go away with the warts?

Thanks!

Who knew warts were such a popular topic!?  We may have to petition whoever’s in charge of these things to make August national wart awareness month.  Anyway, to answer the questions:

The warts are not more infectious after treatment than before.  Assuming a good application, whatever part of the warty skin gets hit by the treatment (freezing, acid) is dead and the virus within it is dead and therefore no longer infectious.  It’s just that the virus may also be on surrounding parts of the skin that look normal and if they aren’t hit by the treatment, then that remaining virus can cause new warts to form.

That kind of answers your second question as well.  The HPV virus is never “in” the body – it only lives on the surface of the skin.  It can be there and never cause a wart at all, and for most people it goes away on its own within 2 years.  So if a wart goes away on its own, you can safely assume that the HPV virus has gone away too.  If the wart goes away because of getting it treated, the virus may still be present on other parts of the surrounding skin and cause more warts to form in the future.

Again, we can offer you lots of effective treatment options at the Student Health Center so if you’re having trouble with pesky, persistent warts, come on in and see us.

John A. Vaughn, MD
Student Health Services
The Ohio State University

 

Are warts still contagious after treatment?

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common wart

When removing the dead skin after treating a wart with salicylic acid, is that area of the hand still contagious with the HPV virus? If so, how can I reduce the chances of spreading the wart?

Another great question from a loyal BuckMD reader!  And on one of our favorite – and creepiest – topics.  We’ve covered how to get rid of warts and whether or not warts from the hand can spread to more private areas, but we’ve never talked about whether or not they can spread while you’re getting rid of them. 

There are a lot of different treatment options for warts, and while they may differ based upon location and other factors, the goal for most of them is to destroy the warty epidermis (top layer of skin) and the virus within it.  After a treatment, the skin will blister or get irritated and eventually slough off.  That skin is dead and so is the virus within it so it isn’t contagious anymore.  Unfortunately, even though the skin around the area of treatment may look normal, there is often virus still present in it. 

So to answer your question – yes, that area of the hand can still be contagious with HPV virus even after treatment.  Since warts are spread by skin-to-skin contact, the best way to prevent further spread is to keep it covered up in between treatments.

We try to extend the area of treatment to include the normal skin right around the wart to prevent this from happening, but HPV is microscopic so it’s impossible to tell whether we’ve gotten it all.  This is why it usually takes several weeks and multiple treatments to get rid of them.

When dealing with warts, you have to be patient and persistent.  But look on the bright side – while they are annoying, common warts are not dangerous and even if you don’t do anything to them, they’ll go away on their own within 2 years in up to two-thirds of people. 

If you’re having trouble with warts, or any other skin problems, come in to see us at Student Health – we’re always happy to help you out!

John A. Vaughn, MD
Student Health Services
The Ohio State University

Pale is Hot – Cancer’s Not! May is National Skin Cancer Month

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Public Health Image Library

Public Health Image Library

Public Health Image Library

In news you can use, the World Health Organization announced that tanning beds definitely cause cancer. Until now, discussions about the cancer causing effects of ultraviolet radiation (either from the sun or from tanning beds) always involved wishy-washy modifiers like probably.   No more! Tanning beds have now officially joined the ranks of other goodies like asbestos, tobacco, coal tar, mustard gas, and (for all you chemistry majors out there) the ever popular N,N-Bis(2-chloroethyl)-2-naphthylamine.

The incidence of melanoma – the worst kind of skin cancer – from ultraviolet light exposure has increased dramatically over the last three decades, particularly in young women.  We aren’t talking about a few isolated cases here, either. According to the American Cancer Society, there were 62,000 new cases diagnosed in the United States in the last year alone, and 8,000 people died from it!  Researchers believe that excessive exposure to UV radiation before the age of 30 is a very significant risk factor for developing melanoma.

The tanning bed industry has long maintained that their beds were safe because they mostly emit the “safe” UVA form of ultraviolet light.  Turns out that in their rush to get you (and your wallets) on their tanning beds, they might have been a little… overly optimistic.  UVA, UVB, and UVC all cause cancer, no matter where it comes from.

The moral of this story, young Buckeyes, is that the healthy glow of a tan is not healthy at all.  This summer, make like an extra from the set of Dark Shadows and go for pale!  Pale is best – put your sunscreen to the test!

Vicki Rentel, MD (Student Health Services Alum)

Reasons to quit smoking that you might actually care about

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photo: nytimes.com

Q: Yeah, yeah, yeah… smoking might give me lung cancer when I’m like 80.  So why should I worry about it now when I can just quit when I’m old?

A: Sure, lung cancer is one of the main reasons to quit, but we know you college (and graduate) students are invincible and don’t really care about little things like mortality, so here are a few other good reasons to quit smoking that might hit a little closer to home:

Tooth Loss

  • It is well known among dentists that smoking dramatically increases your chances of “edentulism” (i.e having no teeth). Smoking causes gum disease and plaque build-up which lead to tooth decay and loss. One study showed that the risk of tooth loss in smokers is more than 4 times that of non-smokers! Think you look cool holding that cigarette? Just think how much cooler you’ll look with dentures. The good news is that the risk of tooth loss decreases with smoking cessation.

Wrinkles

  • Smoking is one of the leading causes of premature skin aging. (One of the identical twins in the photo at the right smokes and has been in the sun more than the other – can you tell which one it is?) Tobacco leads to degradation of the collagen and elastic fibers that keep skin looking smooth and young, leading to premature wrinkles, especially around the mouth and eyes. The mechanisms for this are thought to be similar to the damaging effects of ultraviolet radiation on the skin – so stop tanning too while you’re at it!

Cervical cancer

  • Ladies, did you know that if you have been infected with certain types of Human Papillomavirus (HPV), smoking increases your risk of developing cervical cancer compared to nonsmokers? Researchers are still looking into why this is, but they have actually detected nicotine in the cervical mucous of smokers!  And cervical cancer isn’t one of those things you only have to worry about in the distant future; it is increasingly affecting women in their 20s and 30s. The risk gets higher the longer you smoke, so the sooner you quit the better.

Birth defects

  • It is amazing that in this day and age we still need to tell people to quit smoking before they become pregnant, but unfortunately we still see it all the time. Smoking increases a woman’s risk of premature delivery, still birth, low infant birth weight, and sudden infant death syndrome (SIDS). Since roughly 50% of pregnancies are unplanned, the time to quit is now!

Limb amputation

  • Smoking is one of the major risk factors for peripheral arterial disease (loss of blood flow to the extremities which can lead to tissue damage and amputation). Ok, maybe this is another one of those long term problems you don’t want to think about while you’re young and indestructible, but it’s out there and it affects many people as they get older.

Poverty

  • We know that financial concerns are far and away the biggest stressors for students: tuition, rent, books, fees, not having enough time to study for your classes because you have to work so many hours to pay for them. A pack of cigarettes costs around $5, so a pack-a-day habit costs you $1825 a year! Think about that. How many months of rent or credit hours would that buy? How many student loans could you pay off (or not take out in the first place)? Even if you’re just a casual smoker who only buys a pack on the weekend when you go out drinking, that’s $250 in a year. That would buy you an iTouch!

The thought of becoming a poor, wrinkly, stressed out, toothless, cancer-ridden amputee still not enough reasons to quit?  Check out the CDC’s website for more useful information on the risks of smoking and resources for quitting.  We’ll follow up with another post listing some local resources for quitting soon.

Angela Walker (Ohio State College of Medicine)

John A. Vaughn, M.D (Ohio State Student Health Services)

My toenails look funky

by

UpToDate.com

My right big toe nail cracked across in the middle and I noticed that the left big toe is starting to crack too.  It does not hurt but what should I do?

Certain (kinda rare) medical conditions can cause nails to warp or crack, but when you’re talking just the big toes, you’re usually dealing with a fungal infection. 

People tend to get really creeped out when I mention the word fungus, but it has nothing to do with poor hygiene or anything like that.  Fungi are germs that normally live on our skin; they just happen to like warm, moist places so sometimes they overgrow and cause trouble.  If it happens between the toes, we call it “athlete’s foot”; in the groin area, “jock itch”; under the toenails… “funky toe nails” I guess.  (The actual medical term is onychomycosis).

People who swim or whose feet sweat a lot might have a higher chance of getting a fungal nail infection, but we really don’t know why some people get them and others don’t.  

They happen in the toenails a lot more often than the fingernails and usually start on the big toe, occasionally affecting the nails on the smaller toes.  A fungal infection can cause a nail to:

  • Turn white, yellow or brown
  • Get thick, change shape, or raise up from the nail bed
  • Get crumbly and break off easily
  • Hurt

If your infection is mild or doesn’t bother you very much, you don’t have to do anything about it; it probably won’t go away, but it probably won’t cause any long-term problems either.

There are some over-the-counter creams or nail polishes you can try, but honestly, they’re a waste of money.  If you want to have it treated, you’ll need to take some prescription antifungal pills for about 12 weeks.  Your health care provider may order some blood tests before you start the medicine because they can affect the liver. 

But be warned – these infections can be a pain to deal with.  It can take months for a normal looking nail to grow back in, the treatment doesn’t work 25-40% of the time, and when it does, there’s a 20-50% chance that the infection will come back.  

To reduce your chance of getting a fungal toenail infection:

  • keep your feet clean and dry
  • Avoid sharing nail clippers
  • Wear flip-flops or other footwear in a gym shower or locker room

If you think you have a fungal toenail infection, come in and see us.  We can usually tell just by taking a look at it and asking you a few questions.  If there’s any doubt about what’s going on, we may take a small sample of the nail (cutting or scraping) and send it to a lab where another doctor can confirm which germs, if any, are causing the infection.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Do I need to avoid the sun if I’m on medication?

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PhotoTOXIC reaction

PhotoALLERGIC Reaction

Certain medications cause your skin to become more sensitive to the sun.  Contrary to popular belief, they don’t make you more likely to burn, but actually cause a separate type of painful and itchy rash that can look like a bad burn.  There are two types of photosensitive reactions: phototoxic and photoallergic. 

Phototoxic is the most common.  This happens when the drug itself gets dispersed throughout the body and ends up in the skin, where it absorbs UVA light and causes cellular damage.  A phototoxic event typically happens within hours of initial exposure to sunlight.

Photoallergic reaction occur when the UV light alters the chemical structure of the drug and the body’s immune system sees this new compound as an intruder and attacks it.  A photoallergic reaction doesn’t usually happen right away; it requires longer, and often multiple, exposures to sunlight before it happens. 

Many commonly used medicines can cause photosensitivity:

Antibiotics such as ciprofloxacin (Cipro®), levofloxacin (Levaquin®), sulfamethoxazole/trimethoprim (Bactrim®) and doxycycline, tetracycline, and minocycline.

Acne medicines such as (isotretinoin (Accutane®/Claravis®), tazarotene (Tazorac®), and tretinoin)

Medicines to prevent malaria while traveling like atovaquone/proguanil (Malarone®) and chloroquine).

If you are taking a medication that can increase photosensitivity, you should avoid excessive exposure to sunlight and tanning beds.  (Of course, you already know that you should avoid tanning beds anyway).  If you don’t want to be a shut in while the sun shines, make sure you wear a broad spectrum (UVA/UVB) sunscreen with a SPF rating of 30 or greater.  This will decrease that amount of sunlight exposure to your skin and therefore the risk of a bad reaction.      

Sun Screen Tips:

  • Make sure it is broad spectrum (UVA & UVB)
  • Apply roughly one ounce of sunscreen for the full body
  • Apply one-half teaspoon of sunscreen to smaller body parts i.e. face/neck, each arm and shoulder
  • Apply one teaspoon of sunscreen to larger body parts i.e. legs, back
  • Apply 15-30 minutes prior to sunscreen exposure to ensure optimal protection
  • If swimming or being physically active use a “water resistant” sunscreen
  • Reapply liberally, especially if excessive swimming , sweating or toweling off
  • Minimally use a SPF of 15, optimally use a SPF of 30
  • If applying insect repellant, put the sunscreen on first, wait 15 minutes and then apply the insect repellant

If you are planning on spending a lot of time in the sun while on a medication, be sure to ask your pharmacist about possible photosensitivity side effects.   The pharmacy staff at the Wilce Student Health Center is always willing to answer any questions you may have.  Feel free to stop by or call us at (614) 292-0125.

Dean Wagner, PharmD candidate 2012
Student Health Services
The Ohio State University

Jason Goodman, PharmD, RPh
Student Health Services
The Ohio State University

Photos: www.medicine.net

How Safe is That Tattoo?

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www.pix.10tv.com

The Department of Internal Medicine at New York University (NYU) has a great blog called Clinical Correlations.  The blog is produced by and for physicians so it can be a little technical for the general reader, but it often covers topics that are of interest to everyone. 

A recent post about tatto safety was really good, and very relevant to all you ink-stained Buckeyes out there.  If you’re interested in the details, you can check out the full post here, but here are the highlights:

  • The most common health risk associated with tattooing is localized skin infection caused by Staphylococcus aureus (including MRSA) or Pseudomonas aeruginosa.  A thorough washing of the tattoo site with soap and water is usually effective in preventing localized skin infection.
  • Tattooing can also cause systemic infections such as staphylococcal toxic shock syndrome, pseudomonal abscesses, and infective endocarditis.  If you’ve ever been told that you need to take antibiotics before going to the dentist, you should talk to your health care provider before getting a tattoo.
  • Tattooing has caused tetanus, tuberculosis, hepatitis B and hepatitis C so if you are planning on getting a tattoo, it would be a good idea to make sure your tetanus and hepatitis B vaccines are up to date.
  • Tattoo inks don’t need FDA approval and can contain a wide variety of ingredients that can cause skin reactions.  The most common elements (aluminum, oxygen, titanium, and carbon) have been found to be safe, but mercury, chromium, cadmium, and cobalt are commonly used and have all been associated with delayed hypersensitivity reactions.

These risks are fairly small, but they can be minimized even further by choosing a professional studio to do your tattoo.  You should make sure that the artist changes needles and inkwells, disinfects all equipment, washes her hands and changes gloves between each client.  She should also shave and cleanse the body site with an antimicrobial wash before administering the tattoo and provide appropriate instructions on how to take care of your skin and what problems to look out for. 

If you ever have any concerns about your tattoo, you can make an appointment to see us.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Is Spray Tanning Safe?

by

selftan.co.za

classicbeautytherapy.com.au

Q: Is spray tanning safe?

A: Sunless tanners generally use an ingredient called dihydroxyacetone (DHA), a chemical that reacts with amino acids in dead skin cells on the skin surface to cause a darkened color. The color does not fade but gradually sloughs off with the skin cells over about a week.

The Food and Drug Administration (FDA) regulates color additives such as DHA – if a color additive is used in an unauthorized way, it is considered unsafe under the law. The FDA safety regulations for DHA state that it should only be applied externally to the skin and not to the lips, around the eyes, or to internal body surfaces covered by mucous membranes: mouth, nose, vagina, rectum and lungs (by inhaling it). So home use of sunless tanning products is generally safe, as long as you are careful to avoid those areas. 

Spray tanning booths are a different story. The FDA cannot vouch for the safety of the use of DHA in spray tanning booths since it’s difficult to avoid exposure to the lips, eyes and mucous membranes. If you decide to go ahead with spray or mist tanning, make sure to ask whether your eyes and lips will be protected, and whether you will be protected from internal exposure by inhalation.

Compared to tanning in the sun or using UV tanning beds, spray tanning is probably a safer bet – we all know UV rays cause skin cancer, right?  Just be sure it only sticks to your skin!

John A. Vaughn, MD
Student Health Services
The Ohio State University