With all the warnings against soaking up too much sun, getting ready to go outside can feel like you need a checklist like astronauts use when suiting up for a 6-hour spacewalk in the full blast of the sun’s radiation. Putting on sunscreen and following other sun-smart strategies is for a good cause: preventing melanoma—the most dangerous kind of skin cancer. Curiously, doctors tend not to talk about sunscreen use with their patients. One study showed that, in 18 billion outpatient visits, primary care doctors mentioned sunscreen to just 0.07% of their patients, or roughly 1 in 1,400. But even though your doctor may not mention it, you know better: Put on a broad spectrum sunscreen with an SPF of at least 30 before you go out. Reapply every two to three hours, or more if you are in the water or sweating. Wear a wide-brimmed hat or sun-protective clothing.
Skin and Hair Care
Nearly 7 million adults in the United States suffer from psoriasis. This condition is characterized by red patches of skin covered with silvery scales, often on the elbows and knees. But today doctors understand psoriasis as an inflammatory condition that may affect more than just the skin. People with psoriasis are more likely to have other conditions linked to inflammation, including heart disease, diabetes, obesity, and inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis. And nearly a third of people with psoriasis develop psoriatic arthritis, which causes stiff, painful joints and other debilitating symptoms. Several studies suggest that weight loss and vigorous exercise, both of which help combat inflammation, may help thwart psoriasis as well.
A study published in JAMA Internal Medicine this week found that men who used the erection-enhancing drug sildenafil (Viagra) were 84% more likely to develop melanoma, the most dangerous form of skin cancer, over a period of 10 years. That finding makes for an attention-grabbing headline. But it doesn’t tell the real story—that the study found an association (not cause and effect), that this hasn’t been seen in other studies of men, and that, even if it holds true, the absolute increase is small, from 4.3 cases of melanoma for every 1,000 men who didn’t take Viagra to 8.6 of every 1,000 men who took it. The take-home message is that it’s important to worry about melanoma—which is largely caused by getting too much sun—but not yet about Viagra and melanoma.
A new report suggests that skin cancer can sometimes hide in a tattoo. Writing in JAMA Dermatology, three German clinicians describe the case of a young man who wanted to remove large, multicolored tattoos on his arms and chest. During the removal process, his doctors discovered a suspicious mole inside the tattoo. It turned out to be cancerous—stage II melanoma. Tattoos may make it difficult to evaluate moles. Laser removal therapy is also problematic when moles are present. If you are considering getting a tattoo, either make sure it will be applied to skin that is free or moles or birthmarks, or have your doctor check any moles in the to-be-tattooed area beforehand. If you are planning to have a tattoo removed, check for moles within the tattoo. If you see any, ask your doctor or dermatologist to check them out before starting laser therapy.
As a parent who has dutifully combed nits from my children’s hair, the promise of a no-comb treatment for head lice sounds mighty appealing. An article in today’s New England Journal of Medicine looks like a slam dunk for such a treatment, a medication called ivermectin (Sklice). In two trials, one dose of ivermectin and no nit-combing did vastly better than a placebo treatment. Side effects were also minimal. Keep in mind that the trials didn’t test ivermectin against the current standard treatment using lotions made with permethrin or pyrethrins. And they included under 800 people in carefully controlled situations. That means we don’t really know the true effectiveness, side effects, safety profile, and interactions with other drugs. Until more is known about side effects and how ivermectin stacks up against other treatments, it seems wise to follow the current guidelines from the American Academy of Pediatrics. They call for the use of an over-the-counter product containing permethrin or pyrethrins as a first salvo against head lice, along with combing wet hair with a fine-toothed comb to remove nits.
The FDA’s approval this week of an old drug called ivermectin for treating head lice comes as good news to folks who shudder at the thought of using a nit comb to remove lice. It will be sold as a lotion under the brand name Sklice. Ivermectin works by interfering with nerve and muscle cells in […]
Is sunlight addictive? That provocative idea was raised by Dr. David Fisher, chief of dermatology at Massachusetts General Hospital in Boston, in a presentation at Harvard Medical School. He cited new evidence suggesting that being in the sun stimulates the so-called “pleasure center” in the brain and releases a rush of feel-good chemicals like endorphins, much as happens with addictive substances or activities. Why? Humans need vitamin D to survive. Once upon a time, it came mainly from skin—skin exposed to sunlight makes vitamin D. So the feelings of pleasure we get from sunlight may be part of a survival mechanism to get us the vitamin D we need.
A new FDA approved treatment for head lice, called Natroba, could be a useful addition to the anti-lice armamentarium, since some head lice have become resistant to the active ingredients in current over-the-counter anti-lice products.