Dermatologist Answers Skin Questions From Twitter

Worst thing you can do for your skin is go tanning.

Not only do they cause skin cancer,

but they also accelerate aging rapidly.

Hi, I'm Dr. Muneeb Shah, and this is Skin Support.

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So, @youngforehead, great username.

[laughing]

Should you or shouldn't you pop your pimples?

I'm trying to settle a debate.

All right, let's settle this debate right now.

Anyone who follows me knows

I am very much against popping your pimples.

They can lead to infections.

They can lead to scarring.

We have to think about what causes the pimple,

or where's the pimple in your skin in general,

it's actually stuck inside your hair follicle unit,

or basically inside your pore.

So this pimple is a little pus ball

filled and stuck inside this pore.

Now it's restrained there, which is fine.

It's not gonna cause any scarring at this point.

The second that you pop it,

you actually rupture that hair follicle,

and it damages the surrounding collagen

because of all that inflammation.

So that's where you get scarring.

So definitely don't pop your pimples

if you don't want scarring,

if you don't want that post-inflammatory hyperpigmentation

that sticks around forever.

There are so many good spot treatments out nowadays

that eliminate your pimples pretty quickly

without you having to pop them.

Mugambo Inc. asked,

Why is there no cure for hair loss?

I wish there was because everybody, including myself,

suffers from hair loss.

We don't have an answer yet.

Hopefully one day in my lifetime, we will have an answer.

But all of our cells go through

basically a programmed death cycle.

They can only live so long.

They're all meant to replicate a certain amount of times,

and then eventually die off.

And our hair cells are exactly the same way.

And once they die off, you really can't get them back.

And so we have treatments in dermatology

that can actually stop the hair loss process,

slow the hair loss process,

maybe get you a few hairs back.

But nothing that's a complete cure at this time.

Hopefully one day we do.

But if we are ever to have a cell

that were to continue to replicate forever and ever,

and never die off, that's exactly what cancer cells do.

So we don't necessarily want that.

We need to find something in between

that lasts long enough

that we can produce hair shafts forever,

but not last long enough that it turns into a cancer.

Rockinit4u asks, How safe are tanning booths?

I used to go tanning all the time.

As a result of that,

I ended up developing being skin cancer at the age of 31,

when nobody in my family has ever had skin cancer.

And I went tanning probably over 100 times.

So we know the tanning booths

are gonna increase your risk of skin cancer.

We know that it's gonna accelerate aging.

As a matter of fact,

you have UVB radiation, and you have UVA radiation.

Now, UVB radiation, UVB, B stands for bad.

That's the one that damages your DNA,

and mostly causes skin cancer.

And then UVA mostly causes aging.

Well, our tanning booths are actually mostly UVA.

So not only do they cause skin cancer,

but they also accelerate aging rapidly.

So that's why people that use tanning beds

often look much older than their age.

And so they're not safe,

they increase the risk of skin cancer.

And if there's one thing that I do

on all my social media platforms,

and when I get on here and I talk to all of you

is the worst thing you can do for your skin is go tanning.

Cujo PD asks, Hey Siri, how do I get rid of genital warts?

Probably not tweeting to everybody about your genital warts

would be a good start.

Genital warts are actually caused by the HPV

or human papilloma virus.

And that human papilloma virus

can cause cervical cancer in women.

And it can also cause penile cancer in men.

If you do have genital warts,

that's something you want to get treated.

And it's also something that you don't want to spread

to other people,

especially your partner who could end up with cervical,

or penile, or anal cancer as a result of that.

But once you have it,

we do have several ways to get rid of it,

including freezing them with liquid nitrogen,

and using other topical treatments like imiquimod,

which is a prescription medication

and others that can get rid of them.

But I would have them treated,

and not try to spread them to other people.

But you have different types of HPV vaccines

that are very effective at stopping you

from getting this in the first place.

Now the HPV vaccine is approved up to 45,

but it probably has even benefit beyond that.

There was actually a new study that showed that

up to 87% reduction in cervical cancer in women.

So it actually makes a huge difference if you get it.

And I actually recommend it highly to people,

especially at a young age to prevent getting HPV

in the first place.

Next up, DrChaeEd asked,

How the heck does Accutane work?

Goodness gracious.

So Accutane is actually no longer on the market,

but I actually used that word still myself.

It's actually known as isotretinoin.

So isotretinoin is a vitamin A derivative.

But to understand how it works,

we have to go back to what causes acne in the first place.

So there's a few things that cause acne.

One, your skin cells basically stick together too much

and basically clog your pores.

Two you have bacteria that's stuck in those pores,

clogging those pores.

Three, you have increased oil production,

that's trapped inside your pores.

And four all of that bundle creates inflammation.

So basically, four main things that causes acne.

Accutane, or isotretinoin, targets three out of those four,

very, very effectively.

It decreases oil production,

decreases skin cell stickiness, and decreases inflammation.

And is the number one best treatment for acne.

The problem is that it does have some side effects

that we do need to monitor.

So it's not for everyone.

It's not the answer for everyone's acne,

but for people with really bad nodulocystic,

or scarring acne,

it is an absolute obliterating medication

and life-changing medication for people that have acne.

Next up, we have gigirhmn.

Why does my skin break out when I have stress

as if that won't stress me out more?

Ah, this is such a good question.

So when you have stress, physiologically,

it actually causes you to break out.

This is actually something that's really well documented.

We have a hormone released from our hypothalamus

called corticotropin releasing hormone,

and it actually acts on the sebaceous,

or sweat, or oil glands within the hair follicles

that actually causes acne.

So that stress hormone acts on your hair follicle

to create the oil that causes acne.

That's like the worst thing ever, right?

'Cause you get stressed, you break out,

you're stressed out more because now you have acne,

and it's just a vicious cycle.

And you can actually get in your own head

and make your acne worse.

This is actually true for hair loss too,

that stress can cause hair loss, or telogen effluvium.

And you can end up in this vicious cycle

where your stress is actually making your hair loss worse.

I could just tell you, like, don't be stressed,

but I'm stressed myself,

so I don't really have a good answer for you.

But you know, some meditation in the morning, you know,

exercise and can really get your mind off things,

and just stick with a regimen that works for acne.

And then that will help to improve it.

But I can't eliminate all stress in life, I wish I could.

Mani_poli_me asks,

While we're talking about stuff like this,

is antiperspirant more dangerous than deodorant?

So good question.

And a lot of people just consider these two

to be the same thing, but they're actually very different.

So antiperspirants actually block

eccrine sweat from happening.

So they basically occlude those ducts.

The other side, you have deodorant,

which actually doesn't do that.

It just is basically perfume essentially for your armpits.

Deodorants in general are gonna be considered to be safer,

because there is some risk that people speak of

regarding aluminum.

If you talk to most dermatologists

and most people in the scientific space,

they'll tell you that that risk is unfounded.

So there is some concern that aluminum can cause cancer.

Right now that's unfounded.

So we definitely need more data.

Now, if you're someone who is concerned about this,

I think it's reasonable to just use deodorant.

Now, personally, from my personal opinion,

it's not something that I'm worried about.

I always make my recommendations

based on what I would recommend to my mom,

my sister, my dad, my wife.

Based on my recommendations to my own family members,

I'm not currently worried about antiperspirants,

or aluminum-based deodorants.

That may change as more data comes out.

But if you are somebody who's concerned,

I think it would be reasonable to use deodorant

that doesn't have the aluminum in it.

So sunshinerkayla asks,

Okay I have a question skincare friends.

I've been having issues pretty consistently

with breaking out on my cheeks.

Just the lower part.

I haven't changed anything in my skincare routine,

but it's frustrating.

So this is a really good and common question.

Hormonal acne can affect any part of the face,

but specifically we find that in women,

specifically in their 20s and 30s,

outside of those teenage years,

seem to develop acne along the jawline.

We don't necessarily know why this happens.

Some people think it has to do with different receptors

in the skin at these levels.

But we do know that people get hormonal acne

specifically in this region.

The treatment over the counter is gonna be identical.

So you're gonna look for those acne fighting ingredients,

salicylic acid, benzoyl peroxide, adapalene, or retinoids.

That's all you can do for it over the counter.

It's when you see a dermatologist

that we're gonna treat your hormonal acne different

than we would treat other forms of acne.

So what we would essentially do is go after the hormones,

instead of going after other things

that we usually treat acne with,

we instead go after the actual hormones,

and we give medications that regulate

or normalize your hormone production

to get you back into balance.

So room_aesthetics asks, Why does skin wrinkle with age?

You have to think about volume.

So you have to picture yourself essentially as a grape.

So when you're young, you're a grape.

When you get older, you start to lose volume.

Your volume starts to head in the direction of gravity,

and you develop wrinkles,

or you become essentially a raisin.

And the number two thing is movement.

Now you have to picture yourself as a leather shoe.

So when you get a brand new leather shoe,

it's got no creases in it.

But as soon as you start to move and walk,

it develops essentially a crease in it.

And that's what happens

when we move the muscles in our face.

You develop wrinkles because of that.

So it's volume and movement.

And basically all the treatments that we have

in dermatology, aesthetics, plastic surgery

actually target one of these two things

to eliminate wrinkles.

You gotta ask yourself,

hey, is this anti-aging cream actually gonna work for me?

It has to target one of these things.

It either has to stop movement,

which we don't really have any topical treatments

that can really do that effectively.

There is a topical treatment called argireline,

that may have some benefits similar to Botox

to stop movement.

But beyond that,

we're thinking about how do we restore volume?

So the first thing you can do is protect your volume.

So one thing is to actually wear a sunscreen.

We know that about 90% of the aging that happens to our skin

is actually due to the sun.

And so by inhibiting the sun effect on the skin,

by using sunscreen, that's gonna do most of the work.

The other thing is you can try to build the volume

that you lost by building the collagen

and support structures in your skin.

The number one thing for that,

as far as topical creams is gonna be your retinols

or vitamin A derivatives.

SmartSolariumuk asked,

How dangerous is sunburn?

Can one case of severe sunburn give you cancer?

[sighing]

So sadly, yes, in a way.

Because the way that skin cancers are formed

is basically a mutation in your DNA must occur.

And that DNA mutation leads to rapid replication

of one cell.

So you really only have to get one bad cell

for this all to happen.

And so a really bad sunburn could damage your DNA

to the point where you get an abnormal cell

that does turn into a skin cancer.

Now that is relatively uncommon,

but we do know that just a single sunburn during childhood

can increase your risk of skin cancer by 50%.

Anytime you get more sunburns,

it's gonna be even worse for you.

So not just melanomas,

but you can also get squamous cell skin cancers,

basal cell skin cancers.

You can't reverse what you did in the past.

So you can't go back in time and stop your sunburns.

But what you can do going forward

is wear sunscreen every day,

and really try to get shade

when you're out in the sun at the beach.

Coffeologistt asked,

What is the optimal SPF that I should use on my face?

Right now I have SPF 15,

but I'm not sure if it's protective enough.

Perfect segue here.

So this is a common misconception

because the FDA actually recommends SPF 15.

SPF 15 blocks about 93% of UVB radiation.

We find that that's really not enough in dermatology

because people don't really apply it thick enough

as they're supposed to.

From the American Academy of Dermatology,

we really recommend SPF 30 or higher.

You don't need SPF 100, but SPF 30 to SPF 60

is really gonna get you there.

SPF 15 is probably not enough.

When you get to SPF 30, you get 97% coverage

if you use thick enough of a layer.

Jungolgappe asked, SOS help.

I got a piercing around a month ago

and I've developed an infection in the area.

What do I do? crying face.

So this is July 15th.

So I'm hoping they're okay, it's been awhile.

Hopefully they saw somebody.

Any type of infection,

if it's starting to spread, or become painful,

or draining pus, definitely see a doctor for this.

Probably don't tweet unless the people tweeting back at you

are saying to go see a doctor.

One of the things that you can do

is just clean the area with soap and water,

clean the area with alcohol, chlorhexadine, or iodine.

Any wound, those are the best things

to really clean it with.

So you can use a topical antibiotic ointment,

Polysporin is a good option,

especially in the United States.

Clean the area with soap and water.

If it really starts to get worse,

and you start to have fevers, chills, headaches,

or start to feel really ill,

that's when you want to see a doctor.

KC2SJM asked, Fact or crap:

wind burn can be more dangerous

and last longer than a sunburn.

Is this a fact or is it crap?

Specifically when you're

talking about wind burn or sunburn,

this is actually a great debate

in the dermatology community.

There are some dermatologists

that don't even think windburn exists.

They actually think that windburn is actually just sunburn,

disguised as being in the cold windy times.

My opinion is a combination of both.

When it's windy and cold outside, the humidity is down,

wind is blowing in your face.

Your skin starts to crack and get dry,

and it weakens your skin barrier.

And this makes you more sensitive to the sun

because now that top layer of your skin

can't protect you from the sun.

So it's a combination, wind, low humidity,

plus the sun that actually causes windburn.

The sunburn is actually more dangerous

because it's damaging your DNA.

And the wind burn may last longer

because it's just takes you longer for your skin to heal.

So it's a combination of the two actually.

Guinot_sw18 asks, Does your skin breathe?

And does it need to detox?

Some people will say, hey, my skin's breaking out.

I need to give it a chance to breathe.

What people are experiencing in that situation

is that a lot of times their skincare products or makeup

is actually making their skin worse.

They're using products that are clogging their pores,

or they're using products

that are actually irritating their skin.

And by giving their skin a chance to quote unquote breathe,

their skin may get better as a result of that.

So no your skin doesn't physiologically breathe,

but giving your skin a breather from harsh products

that are damaging your skin barrier

may actually be beneficial for some people.

And we need to sweat

because it eliminates heat from our body.

It regulates our electrolyte productions in our body.

But we don't necessarily need to remove

toxins from our skin.

Our kidneys and our liver do most of the job doing that.

Our skin does very little job to detox our bodies,

Rwlshmakeup asked, Skincare question-

does anyone know why some moisturizers

make my face feel sweaty a few seconds after applying it?

Like not just the moisture layer,

but like I've been sweating.

When you're applying a moisturizer,

you're basically applying like a blanket to your face,

and that increased heat or suffocation of the skin

could essentially cause you to sweat a little bit more.

Moisturizers, actually prevent water loss.

That's the main mechanism by which they work.

So if you start sweating, and you apply a moisturizer,

it's gonna trap that moisture

that's coming out of your pores right into the skin.

And so you may actually be locking in your sweat

and just feeling a little bit more

than you probably normally would.

Next up, we have ted_talk_ideas.

And if they're supposed to last forever,

how does tattoo removal work?

What ends up happening with tattoo

is that you're putting an ink underneath the skin,

essentially into the dermis layer of the skin.

And it basically sits there.

And that's what we see.

When we look at it underneath the microscope,

we see these little particles of black or red dots

sitting in that dermis layer of the skin.

We used to think that tattoos would last forever,

but then they invented laser tattoo removal.

How does it work,

is basically there's a specific laser beam

that targets what we call a chromophore.

Now a chromophore is anything that absorbs light

at a specific wavelength.

If you have black tattoo ink,

the laser will target that specific black tattoo ink

and really nothing else.

And that's the chromophore that it's attacking.

And by hitting that with high power energy,

laser beam essentially explodes these

into tiny little particles

that your body's able to finally absorb and get rid of.

Amiliaachan asked,

Why does my sister have Asian flush, but I don't?

You're luckier than your sister, I suppose,

but it certainly is genetic to some degree.

So what ends up happening with Asian flush or alcohol flush.

They drink alcohol and immediately they turn beet red,

and it's actually kind of painful for them.

It's very, very uncomfortable.

So alcohol needs to be converted and metabolized

to basically the inactive forms of it.

But what ends up happening is people with Asian flush,

they have a mutation in their

acetaldehyde dehydrogenase gene,

and that mutation makes it so

that they can't break down acetaldehyde.

So alcohol is, you drink the alcohol,

it's converted to acetaldehyde,

and then they're not able to break it down.

That acetaldehyde builds up in the body.

It causes tons of inflammation,

flushing, redness, pain, throbbing sensation,

and actually people with a mutation

in this particular enzyme or gene

are increased risk of esophageal cancer when they drink.

'Cause this acetaldehyde is actually really toxic to cells.

It's actually physiologically a dangerous thing

to have Asian flush and drink at the same time.

So it doesn't exclusively affect the Asian populations.

It happens to be more common in the Asian populations

because it's passed through essentially mitochondrial DNA,

which has passed actually from the mom,

usually you inherit your mitochondrial DNA from.

And so it is genetic, it can happen in all populations.

It just happens to be more common in the Asian population.

Next up, Johnnnavent asked,

Curious how you can spot skin cancer.

What does it look like?

And are there any symptoms?

Like I was saying earlier,

skin cancer can kind of look like anything.

But the main thing that I would really want

to warn everybody about is something called melanoma,

which is basically when a mole becomes abnormal.

And that's one of those darker brown looking moles.

We actually do have a really helpful mnemonic for this.

And we call that the ABCDEs of melanoma.

A stands for asymmetry.

So if you were to take a mole,

and you were to lay it over on top of itself,

if it was asymmetric,

that would be one sign that it's not good.

B means basically the borders are jagged or abnormal.

C means that it has more than one color.

So it's not just one homogenous, same color brown.

If there's specs of black,

there's specs of brown, there's specs of pinks,

that's abnormal, you don't want that either.

D stands for diameter,

anything over six millimeters,

or the size of like a pencil head, eraser head,

that's concerning as well.

And the last thing is E or evolving.

So any mole that's changing, growing, bleeding,

all of a sudden doesn't look the same as it did before.

That's something to look for.

And the last thing has actually become

recently recognized in the literature,

what we call the ugly duckling sign.

So basically it's when you have one mole

that just doesn't look like

the rest of the moles on your body.

If you have any of those signs or symptoms,

you want to see a dermatologist immediately.

The depth of how deep that mole goes can be life-changing.

If it goes too deep, it could have already spread.

If it's very shallow,

then we may be able to just remove it right in the office.

So not something to wait on.

Everything else you can wait on.

If you have a pimple or what have you,

but if you have an abnormal or changing mole,

that's not something you want to wait on.

Libb_bbie asked, Can your lips get sunburn?

Something about lip gloss at the beach seems dangerous.

You certainly can get sunburn on your lips.

As a matter of fact,

your risk of sunburn on your lips is actually higher

than the rest of your skin,

because it doesn't have that protective top layer

of the skin called the stratum corneum.

So it doesn't have as much protecting it

as the rest of your body does.

And we do see skin cancers on the lips.

And when we remove them,

it can actually affect the function of your mouth.

And so a lot of people don't even think

to put sunscreen on your lips.

But when you're at the beach,

especially if you're prone to getting sunburned,

you should really actually put on a sunscreen lip balm.

Next up, xtinabebe asked,

Can dermatology Twitter give me some good skincare recs?

Wearing an N-95 all day has my skin breaking out

and it's already a little oily at baseline. SOS.

Yeah, this is a big problem that I saw throughout the year

is just mask related issues.

And that a lot of people contributed it to

mask acne specifically,

but there was this other side of the coin

that was mask irritation.

So just having that mask on your skin all day,

rubbing up against your face,

and also trapping moisture on your face

was actually really irritating the skin.

So there's basically two different piles

you can choose from.

If you have true acne where your pores are clogged,

and you have inflammatory bumps on the skin,

I highly recommend not wearing makeup underneath your mask,

wear nothing under the mask

that's actually gonna clog your pores.

Because if you do, it's actually gonna make acne worse.

Another thing is, you didn't have acne before,

so you may consider adding an acne treatment

to your routine.

So something like adapalene,

or salycilic acid, or benzoyl peroxide,

those are going to be your three top ingredients

for treating acne over the counter.

Consider adding one of them, not all of them,

because that can make irritation worse.

Now, if you have irritation to the skin,

you're gonna want to change your mask out frequently.

Use softer masks, maybe use fabric masks.

You know, change up that regimen.

And then overnight, moisturize,

use zinc oxide paste to help to repair the skin barrier.

So two different camps.

You have to pick which camp you're in,

and then target the treatment at that.

RedBeardLUL asked,

I have a pretty bad cracked heal from the bad skin.

Should I go to a foot doctor or a dermatologist?

This is a good question.

Because in medicine, we always look at, okay,

you have the heart doctor, and they deal with the heart.

And then you have the kidney doctor,

and they deal with the kidney.

When truly, our bodies are all one piece, right?

So you have to really look at it from a holistic approach.

So you definitely have overlapping fields.

And so when it comes to foot care,

dermatology and podiatry definitely overlaps.

So your foot doctor is your podiatrist.

I would prefer that you would see your podiatrist,

'cause I'm personally not interested

in seeing everyone's feet.

But we definitely treat foot conditions in dermatology,

especially cracked feet.

You can definitely see a podiatrist,

we'll both treat you probably equally as well.

One of the things that I highly recommend

for anybody that has that cracked, dry feet,

so anything that has ammonium lactate, or urea in it,

very effective at moisturizing,

and also exfoliating that thick and cracked heel.

All right, that wraps it up.

I hope you learned something.

I know I learned something from all of your questions.

If you have more questions,

make sure to hit Twitter, and we'll see you next time.

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