skin health

What can I do to keep from losing my hair?

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washingtonpost.com

I get this question all the time at the student health center, which tells me that it’s time to drop some scalp science on you.  (DISCLAIMER – We are talking about hair loss in men.  Hair loss in women is a little trickier to diagnose and manage, and should be evaluated by a health care provider.)

You’ve basically got two options when it comes to preventing or treating male-pattern baldness:

Minoxidil (Rogaine) is a topical medication that is available without a prescription.  It comes in a 2% solution and a 5% solution or foam.  (I’ve seen a 15% strength advertised online but this is not FDA approved and is probably made in an off-shore pharmacy so best to stay away from it).  The 5% strength works a little better but has a higher incidence of skin irritation and itching.  The foam may be a little less irritating than the solution.

  • Not covered by insurance – costs around $30 per month
  • Must be used twice a day for at least 4 months before you can say whether or not it’s working
  • The maximum benefit plateaus at 12-18 months
  • It’s successful in about 30-40% of men who use it
  • Once you stop using it, all hair that has been maintained or re-grown will be lost

Finasteride (Propecia) is a prescription only oral medication that comes in a 1mg pill.  It works by blocking an enzyme that converts testosterone to dihydrotestosterone in the scalp.  A 5mg version is used to treat benign prostate enlargement – side effects at that dose include decreased sex drive and erectile dysfunction, but they aren’t seen too often with the 1mg dose.  Although it doesn’t affect testosterone in the body, finasteride has such a high risk of causing birth defects in male fetuses that pregnant women are advised to not even touch the medication.    

  • Also not covered by insurance – costs a little over $60 per month.
  • It’s successful in about two-thirds of men who use it
  • Positive effect continues to increase after 2 years of use
  • Improves not only hair count, but also length and thickness and color
  • Once you stop using it, all hair that has been maintained or re-grown will be lost

So they both work, but not always and only for as long as you are using them.  Finasteride works better than minoxidil and is easier to use, but it’s more expensive and has potentially worse side effects.  They’re both pretty expensive – we’re talking $360 to $720 a year – and you pick up the tab completely.

Like all medicines, you have to weigh the benefits and risks of taking it.  And you don’t need to take anything for your hair.  I mean, sure I’d love to have the flowing mane of Troy Polamalu, but paying 60 bucks a month for a pill that pregnant women can’t even touch!?  I’ll buy a hat, thanks.

But if you feel otherwise, you’re always welcome to come in to the Student Health Center and talk it over with us.

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

Does HPV Really Cause Skin Cancer?

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dfs.chesco.org

Q:  I heard a story on WCMH/Channel 4 recently that HPV causes skin cancer. Is this true? 

Short A:  Maybe.  We don’t really know.

Long A:  We know that there is a cause and effect relationship between certain strains of the Human Papilloma Virus (HPV) and cervical and anal cancers.  A recent study published in the British Medical Journal suggests there might also be an association between HPV and squamous cell carcinomas (SCC) of the skin.  Scientists measured HPV levels in patients who didn’t have SCC and compared them to those who did.  They found that patients had a 44% chance of having SCC if they had 2 or 3 strains of HPV; a 51% chance if they had 4 to 8 strains; and a 71% chance if they had more than 8 strains. 

But while those numbers look scary, they say nothing about whether HPV causes SCC or not.  They imply that there is a correlation between the two conditions, but correlation does not equal causation.  HPV and SCC occur together in a lot of people, but maybe having SCC makes some people more susceptible to getting HPV rather than the other way around?  You could just as easily say, “The more people you see on the oval carrying umbrellas, the more likely it is to be raining.”  But that doesn’t prove that the umbrellas caused the rain.

Here’s another good example of scary numbers, this time from the World Health Organization:

“The use of sunbeds before the age of 35 is associated with a 75% increase in the risk of melanoma”.

So if you’ve ever used a tanning bed, you have a 75% chance of getting melanoma!?  No.  That number is the relative risk.  The absolute risk of getting melanoma from tanning beds is actually very small: less than 0.003% of people who tan frequently get melanoma, compared to less than 0.002% of people who don’t.  While that rate is 75% higher, we’re still talking about a very small number – less than 3 out of 1000.  There’s a great article explaining all of this stuff over at the Association of Health Care Journalists website.

I’m NOT saying tanning beds are safe.  Melanoma is bad and even though it doesn’t happen that often, anything that increases your risk of it even a tiny bit should be avoided.  You should wear sunscreen and condoms as often as possible (well, you know, when appropriate… and maybe not at the same time… you know what I mean).  My point is that numbers can say very different things depending on how you look at them, and people will often exploit that fact to sell you stuff from milk to medicines, and not always with your best interests at heart. 

Being an informed and knowledgeable health care consumer is as important to your health as sunscreen and condoms.  So lather up, cover up and always read the fine print.  You’ll be glad you did. 

Victoria Rentel, MD
Student Health Services
The Ohio State University

Too much of a good thing . . .

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twolia.com

I’ve heard I’m supposed to wear sun block all the time, so I’ve been using an SPF 15 that’s included in a moisturizer.  If I use a higher SPF on a daily basis, is there anything nasty in it that wouldn’t be good to have on my skin 24/7/365?

A great question for the first day of summer!

There are quite a few rumors out there about sunscreens. Let’s shed some light on the subject:

  • A high SPF guarantees protection: There are two kinds of risky rays: UVA and UVB. Believe it or not, the present rating system is only for UVB. An SPF of 8 billion may tell you that you could walk on the surface of the sun without a single UVB ray getting to you, but it says nothing about how many UVA rays will microwave your skin when you’re walking around the Oval. The FDA is working on this, but for now, it’s all we’ve got.
  • The higher the SPF the better: There’s actually not a lot of incremental benefit as SPF increases. Going from SPF 15 to SPF 30 only blocks about 3% more UVB, and going from 30 to 40 only improves things by about 1%. Higher SPF products can cause more allergic reactions to product ingredients so if you want to go higher than 15, going over 30 probably won’t provide much extra benefit. Regardless of SPF, you should always apply sunscreen generously and reapply often.
  • Sunscreens cause cancer: There is a mountain of evidence that sunscreen prevents skin cancers, particularly squamous cell carcinomas. There was some speculation that if newer ingredients like oxybenzone, avobenzone, titanium and zinc oxide (for UVA protection) were absorbed through the skin they might mess with estrogen and testosterone levels and put people at an increased risk of cancer but there’s no evidence that this actually occurs in humans.
  • Never, ever go out in the sun without protection: You will never be sorry you used sunscreen on your face. Leaving the issue of cancer aside, sun supercharges wrinkles and other signs of age (sagging, discoloration). For the rest of your body, though, it’s not as clear. The problem is partly with our climate. We need sun to convert precursors in our skin to Vitamin D. Given that we spend several months of the year practically sun-free, many Buckeyes have Vitamin D deficiency. While there is some evidence that low levels increase our risk for certain cancers, there are real risks of Vitamin D deficiency, for example, osteoporosis and an oldie but a goodie, rickets. It doesn’t take a lot of sun exposure to generate Vitamin D production in the skin, only 10-15 minutes a few days a week.

In general you’re okay if you:

  • Apply sunscreen generously and reapply every couple hours if you must remain outside.
  • Stick with a sunscreen with an SPF of 15-30.
  • Look for a sunscreen that offers UVA and UVB protection. Look for the American Academy of Dermatology seal of approval.
  • Here in Central Ohio, it’s probably okay to skip the sunscreen for brief exposures of 10-15 minutes two-three times a week during non-peak hours. (Peak hours are 10am-4pm). Cover up that face, though.
  • If you’re worried about your Vitamin D supply, schedule an appointment to discuss a diagnostic blood test and/or dietary replacement with your healthcare provider.

For more than you ever wanted to know about UVA, UVB, and the evidence about sunscreen, cancer, and toxicity, click here.

Victoria Rentel, MD (OSU SHS)

Icky Feet!

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The latest in foot care technology?

To everything in primary care there is a season. Winter, for example, to me will forever be associated with runny noses, the flu, and the smell of Purell.  Summer is filled with poison ivy and sunburn.  Autumn brings allergies and sports physicals.

Spring for me is feet.  

As soon as the flip flops and sandals come out, patients start showing me their flakey and discolored toe nails; cracked dry heels; and their athlete’s foot. If you have a fungus among us-either in the toenail or the skin-then you need to see us for some of our prescription mojo.  But those dry, rough heels? You can deal with those yourself.

Dry skin on your heels is just a build-up of a lot of dead tissue, and it needs to come off. You’ll need a little elbow grease and a good, thick emollient. Go to your local grocery or big box store (i.e. Target) and pick up something to grind that tissue away, preferably something with two sides like sandpaper: a coarse side and a fine grit side. In fact, you can use actual sandpaper!  Ideally, 60-grade aluminum dioxide sandpaper on a sanding block, which basically makes a giant emery board.  It’s cheap, one package lasts forever, and it gets the job done.

Gently attack those rough, tough, thick areas on your heels, a little at a time. Wash off the powdery stuff that is left with soap and water in the shower, or soak your feet for 10 minutes or so in warm water.  When you’re done, apply a very thick emollient, like petroleum jelly, Eucerin (in the tub), Aquaphor, or something with lanolin. If you have time, throw on a thick pair of cotton socks for a few minutes to let that stuff work its magic.

Do this a few times a week and after a month or so you’ll have feet worthy of your finest gladiator sandals!  If you’ve been toiling away at foot perfection and it just isn’t working, come on in to see us.  We’ll set you up with a lotion that will help eat away that dead skin.

If you’re diabetic, have problems with your circulation, or have open wounds or pain in your feet – don’t try this at home.  You should have a foot specialist take a look to make sure nothing more serious is going on and you don’t do any damage to vital structures.

If you have questions or aren’t sure about the low down on your feet, get on the horn and make an appointment with your health care provider – we’re here to help you out. 

Victoria Rentel, MD (OSU SHS)

photo: ehow.com

So how do I get rid of warts?

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Mediplast - click to enlarge

daddytypes.com

Q:  So how do I get rid of these warts?

A:  In my post last week, I hopefully reassured you that you don’t have to worry about warts on your hands spreading to more sensitive areas.  Now let’s talk about what you can do to get rid of those annoying little suckers!

Cryotherapy:  This is the granddaddy of wart treatments.  We soak a cotton swab in liquid nitrogen and apply it to the wart to freeze it and the surrounding skin.  You can get an over-the-counter kit to do this yourself but they’re kind of expensive and we can usually do a better job for you.  About 75% of warts clear with liquid nitrogen therapy, but it often takes at least a couple of treatments spaced a few weeks apart to get the job done.  It stings a little but the freezing kind of numbs the area so it isn’t too bad; most people get some redness and irritation for a few days afterwards, but it’s pretty mild.

Salicylic acid: There are a lot of over-the-counter (OTC) salicylic acid preparations available out there – Compound W is probably the most recognizable brand name.  The Student Health Pharmacy also has a plaster (MediPlast) that is a lot stronger and more effective for tougher warts and those in areas with thicker skin, like plantar warts.  They are available without a prescription and cost less than 2 bucks each.  They’re about the size of an index card – you cut off a piece big enough to cover the wart, peel the paper off the back, stick it onto the wart and leave it on for 24-48 hours.  You can cover the plaster with a piece of tape to hold it in place if necessary.  You peel it off and then scrub away the dead skin and repeat the process until you get to the bottom of the wart.  It may take a few weeks, but is also about 70-80% effective at cure.

Squaric acid: The new kid on the block for wart treatment at SHS is squaric acid.  It is a 0.2% liquid compound that you apply directly to the wart once a week for 6-8 weeks, leaving it on for 24 hours at a time.  How it works isn’t exactly known, but it sensitizes the skin and stimulates the immune system to attack the wart.  There isn’t a lot of research into how effective it is compared to other treatment options, but in my limited experience with it, it has been effective when other treatments failed.  It requires a prescription and is also inexpensive. 

Duct tape: People have been using good old fashioned duct tape to treat warts for a long time.  Medical researchers have actually looked into this and some studies found it to be effective while others didn’t.  The best I can tell you is if you’re going to try it, use the silver form of the tape since the rubber-based adhesive sticks to the skin better (unless, of course, you’re allergic to latex).  The studies that showed benefit had people leaving the tape on for 6 straight days, then removing it, soaking the wart and scrubbing away the dead skin.  The process was repeated until it was gone.  You can apply a 17% OTC salicylic acid to the wart before covering it with the duct tape but if you do, remove the tape and check the wart every 24 hours since this increases the chance of having a more severe reaction.

There are a few other options out there which we can discuss with you, but those are the biggies.  If you’re having trouble with warts, or any other skin problems, come in to see us at Student Health – we’re happy to check it out!

duct tape photo: daddytypes.com

mediplast photo: concentric.net

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

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, Med IV (Ohio State College of Medicine)

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

What are these bumps in my beard?!

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photo: emedicine.com

Q: Help! What are these bumps in my beard?! 

A: Pseudofolliculitis barbae (“razor bumps” or “shave bumps”) is a fairly common problem, affecting 50-80% of African-American men and around 3% of Caucasian men who shave their facial hair. The cheeks and neck are the most common areas affected. The bumps can be itchy, painful, or just plain unsightly and scratching them can lead to bacterial infection and scarring.

Many people confuse this condition with acne but this is not the case. Pseudofolliculitis barbae typically occurs when curly facial hairs are shaved off (which makes them sharper and shorter) and then curl back in and pierce the skin, causing an inflammatory reaction.

Stopping shaving and allowing the hairs to grow out usually fixes the problem. For acutely inflamed bumps, it is best to stop shaving for at least one month – you can use an electric trimmer to keep the hairs short, but should let them get no shorter than ¼ inch. You can also relieve the inflammation by applying a warm compress for 10 minutes, 3 times a day and applying hydrocortisone cream (1%) afterwards. 

For men who are unwilling or unable to grow a beard, some tips to minimize symptoms when shaving include:

  • Allow hairs to grow to at least ¼ inch
  • Rinse face and apply warm water compress for a few minutes
  • Use a generous amount of a lubricating shave cream or gel (i.e. Easy Shave) and allow to sit for 5-10 minutes to soften hairs before shaving
  • Use only a very sharp razor and shave in the same direction as hair growth
  • After shaving, rinse face with water and apply cold water compress
  • Look for any embedded hairs and try to dislodge (don’t pluck!) with a sterile needle or tweezers

There are also topical medications that can be used to treat more severe symptoms. Tretinoin (Retin-A), Benzoyl Peroxide and Clindamycin have all been shown to reduce symptoms. The only definitive cure for pseudofolliculitis barbae is permanent removal of the hair follicle or laser hair removal. These can be expensive and painful solutions so may not be for everybody.

If your shaving bumps persist after trying some of the steps listed above, see your doctor to talk about treatment options.  The physicians at Student Health Services are always happy to help.

Angela Walker, Med IV (Ohio State College of Medicine)

Muhammad Khan, MD (Ohio State Student Health Services)

 

It’s all about the hair, baby!

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photo: canpages.ca

Q: I’ve been shedding a lot of hair lately. Could I be going bald like my dad? Does baldness run in families?

A:  Hair normally grows in cycles that last between 2-3 years. About 90% of the hair follicles on the scalp are actively growing hair at any one time. The remainder are resting or involuting. It is normal to lose about a hundred hairs each day from all over the scalp.

“Male pattern baldness”, or androgenic alopecia, is common to both males and females, believe it or not.  It typically starts as a receding hairline, especially on the sides, and a bald spot in the back. Medical lore used to hold that if your maternal grandfather was bald you would be too, but we now know that genetics is only part of the problem.

The most common cause of pathologic hair loss is stress, both psychological and physiologic: think trauma, dissertation defense, pregnancy, severe illness, significant weight loss, etc. This is called telogen effluvium. It is almost always reversible and usually happens 3-4 months after the stress. 

There are a variety of other medical, pharmacologic, psychological, infectious, environmental and hormonal causes of hair loss.

  • Traction alopecia from crazy tight hair-dos
  • Ringworm in the scalp (tinea capitis)
  • Diabetes, lupus, iron-deficiency anemia, and thyroid disease
  • Trichotillomania, a psychological disorder where sufferers compulsively pull and tear at their hair (and sometimes eat it)
  • Alopecia areata (think Dr. Evil) is a potentially treatable autoimmune disease that causes patchy hair loss.

If you’re worried about your hair-or lack thereof- be sure to visit your primary care provider to talk about it.

Adam Brandeberry, Med IV (Ohio State University College of Medicine)

Victoria Rentel, MD (Ohio State Student Health Services)

Pale is Hot – Cancer’s Not!

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see... pale is hot!

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 Twilight and go for pale!  Pale is best – put your sunscreen to the test!

Vicki Rentel, MD (Student Health Services)

Say No to Scarlet Skin!

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The signs of spring are finally here! Mirror Lake has thawed, joggers are out, and the Oval is packed with eager sunbathers whose skin is so pale, the reflection is blinding drivers on High St.   Your skin uses a chemical called melatonin to protect itself from UV rays. The more sun you get, the more melatonin is produced and the more your skin takes on that golden glow you love so much.

Excessive sun exposure can put you at risk for melanoma, one of those most deadly types of cancer and one that is becoming increasingly common.  If you watch Grey’s Anatomy, this is the cancer that Izzie Stevens has. Your skin is especially vulnerable to getting burned early in the year when it doesn’t have defenses in place.

Melanoma is not just a disease of old people; it can attack at any age. The good news is that it is preventable with diligent sunscreen use and can be treated if caught early enough.  You should use a sunscreen with a 15 SPF or greater – don’t worry, you’ll still get a tan! – and be sure to apply a generous amount to your entire body, especially to your ears, nose, and even eyelids. Using a chap stick with sunscreen for your lips is also a good idea. These areas with thin skin are especially vulnerable to skin cancer. Lastly, remember to wear a waterproof sunscreen if you’re swimming.

Having moles on the skin is normal, but you should watch out for any that change in size, color, or texture.  You should have any suspicious spots on your skin checked by your primary health care provider.  More information can be found here:

http://www.cancer.gov/cancertopics/wyntk/melanoma

Have fun and enjoy the spring weather!

John Vaughn, MD – Ohio State Student Health Services

Adam Brandeberry, Med 4 – The Ohio State University College of Medicine and Public Health