Time to learn our ABCD’s

photo credit: bettergov.org

photo credit: bettergov.org


The ABC’s. It’s one of the first things we learn as kids right? We even have a catchy little song to help make the alphabet easier to remember. It seems pretty simple….until it isn’t. In the field of dermatology the alphabet is used as an acronym for the clinical detection criteria of melanoma, the deadliest form of skin cancer. The conventional ABCDE’s of melanoma are Asymmetry, Border, Color variegation, Diameter >6mm, and Evolution [any change in morphology or symptoms of the lesion]. A recent study conducted through the University of California, San Francisco, has demonstrated that we need to learn some new ABCD’s. This retrospective study evaluated patients diagnosed before the age of 20, during the time period from 1984-2009. 60 pediatric patients with melanoma as well as 10 pediatric patients with ambiguous melanocytic tumors treated as melanoma (i.e. lesions had atypical clinical presentations and ambiguous microscopic features). The study patients were divided into group A for ages 0-10 and group B for ages 11-19. The conventional clinical ABCDE detection criteria was absent in sixty percent of group A patients and 40 percent of group B patients. What emerged from the study was a new set of ABCD’s common to diagnosis including Amelanosis (lack of pigment), Bleeding and “bumps”, uniform Color, variable Diameter and De novo development. Not only were the clinical features different from the conventional, but it was also found that current microscopic subtypes of melanoma could not be applied to 44 percent of cases.

What does this all mean? It means that more research will need to be done to expand upon this research to help determine the most appropriate clinical and microscopic detection criteria for melanoma as it relates to the pediatric population. The good news, is that it means that the field of dermatology continues to evolve and change as new information reaches the forefront to best diagnose and manage our patients. It also means that as parents and caregivers of children we need to have a heightened awareness of bleeding lesions, bumps and lumps both colored and colorless that have newly developed or recently changed and have them evaluated. It means we need to learn our ABCD‘s.

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Time to celebrate!

Camp Korey

Today is a day of celebration. We celebrate our country. We celebrate the freedoms we enjoy as a result of our forefathers declaration of independence. We celebrate the special memories we get to create with family and friends as we gather around picnic tables, bonfires and watch Technicolor fireworks illuminate the sky in honor of this declaration. Sure, we celebrate a day off work and throw in some good sales too, why not? In the spirit of celebration and honoring amazing things, I wanted to share my adoration for Camp Korey. What is Camp Korey? I am so glad you asked! Camp Korey is an amazing haven that provides recreational programs for children and young adults with serious medical conditions who are unable to attend traditional enrichment programs due to their high medical needs. Camp Korey is a place that provides kids the opportunity to build self-esteem, meet friends that can relate to similar challenges and empower them to try new things rather than feeling isolated or limited as they might elsewhere. It is the place where pure joy is palpable.

I had the privilege of volunteering at Camp Korey as medical staff this past week. On a larger scale, the camp is part of the Serious Fun Children’s Network and in partnership with the American Academy of Dermatology hosts Camp Reflection, which is a camp specifically geared towards children with skin disorders and is held on the Camp Korey campus. As a dermatologist, I had the opportunity to oversee the medical care of children with both relatively common skin conditions such as atopic dermatitis to rare entities that most of us only read about during our training. The diversity of skin disorders at camp may have been vast, but the love of fun, camaraderie, mutual respect and unwavering support was homogenous. The kids had a blast, and no one was left behind or left out. From the beginning of camp where a young woman had such severe social anxiety that she wouldn’t utter a word to me, to the end of camp where she bestowed upon me a smile that could light up the darkest of skies, it was magical. Although I was there to serve in a professional capacity as a physician, I was gifted a profound personal re-awakening. Today is a day of celebration of our nation’s independence, but I would suggest that every day should be a celebration. The kids at Camp Korey reminded me that we can and should celebrate our abilities, but we should also celebrate our limitations to help catapult us beyond them to achieve true bliss. Happy 4th everyone!

What you didn’t expect when you’re expecting

Aah, the joys of pregnancy. You are basking in the glory of carrying your bundle of love. Your hair is more lush and plentiful, you have that “glow”, you can indulge your every craving guilt free, and you can finally fill out that low-cut top you’ve coveted without any er, um…supplemental padding. But alas, you discover that the “Girlfriend’s guide to pregnancy” left out a few significant details about what could happen to your skin over the course of those nine months. Well, girlfriend, I’m here to tell you ugly truth. Your skin is your window to what’s happening on the inside. With a baby growing inside of you, your body is functioning in overdrive and all that growth and change happening for the baby translates into a lot of growths and changes with your skin, hair and nails. Having gone through this process a few times myself, I have had the unfortunate pleasure of experiencing a few of these lovelies and the good news is that most of the changes I’ll detail below do go away after pregnancy, and those that linger can be “taken care of” shall we say, by your local dermatologist. So even though you didn’t expect these things when you found out you were expecting, don’t worry, I’m here to guide you through it.

Lumps, bumps and tags oh my!

photo credit: skincare-service.com

photo credit: skincare-service.com


a.Common benign growths during pregnancy include skin tags also known as acrochordons or fibroepithelial polyps which love to occur in all the inconvenient places like crevices and skin folds for example around your neck, in your armpits, along your bra line and groin. They also like the face, especially around the eyes. Skin tags are typically skin colored or hyperpigmented(darker)lesions 2-5mm in size that may be smooth or irregular in appearance and are often raised from the surface of the skin on a fleshy stalk. They are usually asymptomatic unless they get irritated or itchy from being rubbed by clothing or jewelry. Other than being seen during pregnancy, skin tags may have a causal genetic link as well as a link to metabolic syndromes such as diabetes. These lesions can easily be removed if desired or warranted via cauterization, cryosurgery, excision or surgical ligation.

b. Seborrheic keratoses:

photo credit: finantempleton.com

photo credit: finantempleton.com


These benign lesions are raised thickenings of the skin that typically appear as variable shades of brown and can appear black at times raising concern for a differential diagnosis of melanoma and therefore are likely to be biopsied for confirmation. Some refer to seborrheic keratosis as “barnacles on the ship of life” as they typically appear later in adult life. I personally refer to them as “gifts of maturity”. Now granted, it’s like the gift from your Aunt Minny, you really don’t want the gift, you have no need for it and it’s downright ugly, but you can’t give it back and you can’t exchange it, so you might as well make the most of it and give it a nice name right? Just like tags, they don’t need to be removed, but if they become irritated or bothersome the same methods of removal for tags can be used for seborrheic keratoses.

c. Pyogenic granuloma:

photo credit: procedureclinic.com

photo credit: procedureclinic.com


These lesions are also referred to as granuloma gravidarum, eruptive hemangioma, granulation tissue-type hemangioma, lobular capillary hemangioma, and tumor of pregnancy. I had the distinct displeasure of having one of these in my mouth during pregnancy, a common location, and in this location it is coined an “epulis of pregnancy”. A pyogenic granuloma or epulis is essentially granulation tissue which appears as an overgrowth of tissue due to irritation, physical trauma or hormonal factors. Because they are composed of groups of blood vessels they are extremely friable and can bleed significantly with minor trauma. The good news is that they often resolve spontaneously. The caveat is that if a lesion doesn’t resolve on it’s own and removal is performed but incompletely so, the lesion can recur with “friends” i.e. multiple lesions can occur. Again, being a benign lesion this is not a long term concern, but acutely it can raise false alarm for more concerning skin conditions including malignancy if you don’t inform your doctor of your prior procedure.

d. Cherry angiomas:

photo credit: byebyedoctor.com

photo credit: byebyedoctor.com


Who doesn’t like a cherry on top? Well, when it comes to having them all over your body you may not. Cherry angiomas are another vascular benign neoplasm that can occur at all stages of life from childhood to adulthood, but it seems that during pregnancy they like show up even more. These lesions range from 2-5mm and may be flat or raised. The larger the lesion, the more likely that it may bleed with minor trauma. An important thing to know about these lesions that if they do become traumatized they take on a blue/black appearance which similar to seborrheic keratoses, can mimic melanoma and prompt a biopsy to rule out this possibility. Unlike pyogenic granulomas and skin tags, cherry angiomas linger long after pregnancy and in most cases become a permanent fixture on your body. Like most other lesions though they can be removed via excision, cauterization or laser therapy.

e.Nevi/moles:

photo credit: hawaiidermatology.com

photo credit: hawaiidermatology.com

These are benign lesions comprised of melanocytes which are your pigment producing cells. They range in color from flesh-colored to shades of brown. Melanocytes are also the cells which give rise to melanoma, the deadliest form of skin cancer. Melanoma can arise de novo, meaning the lesion originates as a cancer, or it can evolve from a pre-existing nevus/mole that undergoes changes in terms of its size, shape and color. During pregnancy it is not uncommon that pre-existing nevi/moles become darker than they were at their onset due to an increase in a hormone called melanocyte stimulating hormone. This darkening effect can be seen in other areas where melanocytes are found including genital skin, breast areolar tissue and that line from your belly button to your pubic area which is referred to as the linea nigra. Following pregnancy, the affected lesions and skin may return to their previous state, though more commonly they remain slightly darker than they were originally. The concern for melanoma is low in these situations unless it is noted that a pre-existing lesion has significantly changed in size, shape as well as color or a new lesion has appeared during pregnancy that stands out from all the other lesions a patient has, both of these scenarios may prompt a biopsy for further evaluation.

There are a host of other issues that may arise during pregnancy including: soft, brittle nails that grow at warp speed; outbreaks of acne; spider veins; stretch marks; melasma (patchy darkening of facial skin: the key is sun protection); new rashes that itch as well as exacerbation and new manifestations of underlying skin conditions like psoriasis and immuno-bullous disease. And if that weren’t enough, that luscious head of hair you acquired during pregnancy is going to start to shed starting around 3 months postpartum and last for about 3 months known as telogen effluvium. Sounds awful doesn’t it? Don’t worry, most women experience a few of these things but not all of them, and most of these issues resolve spontaneously. For all other issues and any lesions that concern you, consult your local dermatologist.

Pregnancy may not be all rainbows and butterflies, but at least now you know what to expect right? Good luck and enjoy the journey!

Did you smell that?

photo credit: Zazzle.com

photo credit: Zazzle.com


Depending on what it is you may hope you didn’t right? Well as a Mom of two kids and two dogs, needless to say there are some er..um, unpleasant odors permeating the house on a not so infrequent basis. Now I realize that offensive smells are not directly related to skin care, but the fragrances and products used to camouflage said scents can be irritating if they come in contact with your skin so I thought this would be a good segue, yes? Bad smells are not the kind of thing most people like to talk about at the bus stop, in the coffee shop, or in the grocery checkout lane (although quite frankly it may help pass the time when you’re stuck behind the person with 50 items in the express 15 item limit line, did she not see the sign?), but I’m not like most people. So bear with me.

I wouldn’t say I have a huge nose by most standards but it’s certainly not petite. Not one of those cute button noses. Any hopes of having a “cute” nose washed out at sea when I got kicked playing water polo at the beach as a kid. I know, I know, who plays water polo in the ocean with strong undercurrents right? Exactly, so I get pulled underwater by the current, get kicked in the nose, blood everywhere….The good news was that my nose wasn’t “broken” per-se, more like “adjusted to the right slightly”, but the end result is that my nose doesn’t quite work like it used to, making breathing a bit more difficult. What I lack in breathing prowess however, I make up for with olfaction. It’s like my sense of smell went into overdrive after that fateful day at the beach. There are many times I wish this was not the case, believe me…I am constantly asking people, “Do you smell that?” and of course they don’t so I am left to endure the stink in solitude. Spending more time indoors since our move to the perpetually soggy Northwest, my inner voice is still yapping away, and she says she’s had it with all the over-chemicaled, synthetic, “can’t pronounce a single ingredient on the bottle”, skin irritating air fresheners, so I have indulged her again and found a solution for my lonely sniffer…homemade air freshener spray!

I have come across recipes that use only water or only vodka, but I have found that an equal ratio of both works best for me, but feel free to experiment. The alcohol will break down the oil while leaving the scent intact, allowing you to mix it with water. The added bonus is that alcohol has anti-bacterial, anti-viral and anti-fungal properties, so if the spray gets on any surfaces, you can pat yourself on the back for multi-tasking…disinfecting and deodorizing!

So here are the basics:
4 ounce spray bottle (I prefer glass. Essential oils are stored in glass to prevent degradation, so I figured why mess with it, I can’t afford to have the good smell go away!)
2 ounces distilled water
2 ounces vodka (Any kind will do, but the cheaper the better because you may go through it fast if you get spritz happy.)
20-40 drops essential oils (The potency of oils vary so you can tailor the amount used to your preference. Also, several oils have anti-bacterial properties so in case you really do want to multi-task you may want to try: lavender, maleluca oil(tea tree), geranium and lemon.)

My favorite combinations are:
a. lavender and rosemary
b. lavender and sweet orange
c. cedar wood, rosemary, rose geranium, lavender (I know, I know, I can’t help it, I really like lavender)
d. eucalyptus and spearmint (seriously refreshing)

So the next time someone asks you, “Did you smell that?”, you can be armed and ready with your homemade air freshener. And who knows, you may actually enjoy talking about bad smells to total strangers once you find your olfactory bliss like me!

Sticks and stones….

photo credit: lyceum group

photo credit: lyceum group

Most of you know how this saying goes, but I’ve added my own spin on it so I’m giving it a whirl:

Sticks and stones may break your bones

But Sunburns can really hurt you!

For those of you who are willing to entertain my version of nursery rhymes, thank you because I’ve taken liberties to take it one step further…

I’m rubber and you’re glue

I hope what I tell you about sun safety, skin cancer and melanoma bounces off me and sticks to you!

I know what you are probably thinking. That’s so juvenile right? Maybe Dr. Barr washed down some goldfish with too many glasses of red wine. Could she be more childish?

But that is the whole point of this post…children. Your children, my children and children all over the world. Anyone with a relationship with a child (could be your best friends’ child, a niece/nephew or your own)  has experienced that undeniable instinct to protect them from harm. It doesn’t matter what form the threat of harm may take, whether it be psychological or physical, we as adults, put on our proverbial armor and prepare ourselves to defeat the perpetrator to a child’s well-being.  Somewhere along the way however, our armor got a chink in it and we have failed to adequately protect our children (let alone ourselves) from the damaging effects of the sun. Research recently presented at the American Association of Cancer Research meeting confirms our shortcomings. Although the incidence of melanoma in childhood is rare, statistics show that the frequency of children and adolescents diagnosed with melanoma is on the rise.

Data pooled from numerous U.S. cancer registries highlighted that the incidence of childhood and adolescent melanoma has increased an average of 2 percent per year spanning the time period from 1973 to 2009. Of note, girls had higher incidence rates than boys, and compared to younger children so did those aged 15-19. Similar to their adult counterparts, girls had higher rates on their lower limbs and hips, while boys had higher incidence on the face and trunk. While further research needs to be performed to determine the factors contributing to the rising incidence, we don’t have to wait for additional data to be pro-active about vigilant protection of children and adolescents from the damaging effects of UV radiation.

Wearing wide-brimmed hats, sunscreen (with re-application at least every 2 hours) and wearing UPF rated clothing (30 and above) coupled with modifying hours spent outdoors to avoid high intensity UV-radiation (currently recommended between 10a-4p but that may be hard to do, so doing your best to avoid 12-3p may be easier) are crucial steps in protecting children and adolescents more delicate skin. But that’s only part of the solution.

Artificial UV radiation sources found at tanning salons are a significant contributing factor as I touched on in my What’s the big deal post. UV radiation from tanning devices are a significant contributor to the rising rates of both non-melanoma and melanoma skin cancer.

We know that Ultraviolet A (UVA) and Ultraviolet B(UVB) rays contribute to the development of skin cancer of all types. UVB is primarily responsible for contributing to sunburns. UVA rays penetrate deeper into the skin and contribute to premature aging of the skin including: alterations in pigmentation (brown spots), fine lines, wrinkles and loss of elasticity that contributes to a leathery appearance. Together, the synergistic effect of UVA and UVB rays contribute to the development of skin cancer. Of note, an Australian-US study has demonstrated that UVA causes more genetic damage than UVB in skin cells where most skin cancers arise – the keratinocytes in the basal layer of the epidermis. This information is critical as most tanning devices emit UVA radiation.
So what’s the bottom line you ask? It’s pretty simple: don’t let kids go to tanning salons and practice sun-safe behavior every day. Being sun-safe doesn’t mean you have to stay indoors, rather it’s a lifestyle choice. Choosing clothing that protects a greater proportion of your skin, altering the times of day you pursue your outdoor activities and putting on sunscreen as part of your daily personal hygiene regimen can easily be incorporated into your daily routine.

So how does this nursery rhyme end? Here goes:
Sticks and stones can break your bones
But Sunburns can’t hurt you if you are sun-savvy!
Doesn’t rhyme but I never said I was Dr. Seuss. Cheers to finding your Shaded Bliss!

References:
1. Skin cancer foundation: skincancer.org
2. Pediatrics Vol. 131 No. 4 April 1, 2013 pp. 772 -785

The Versatile Blogger Award

versatile_blogger_award

My gratitude goes to Sheila, the goddess of The Summer Goddess of Dark Shadows for bestowing this award on me. Please visit her site! So the rules of this award require that I share seven things about myself, so here they are:
1. I could eat pizza for breakfast, lunch and dinner…the possibilities are endless
2. I may be tone deaf, but I still rock out in my car so no one else can hear me and complain
3. Princess Bride is still one of my all time favorite movies after all these years
4. I have lived in a lot of college towns, but I will always be a Wolverine, “GO BLUE!”
5. One of my guilty pleasures is looking at houses and scouring interior design websites…part of me really wants to be an interior designer/architect
6. I am married to my best friend (this really is my number one)
7. I am a perpetual klutz

Now for the fun part! I have the pleasure of bestowing this award to other blogs. As I am just getting starting with my blog and this experience, having the opportunity to explore so many of the amazing blogs out there is a wonderful opportunity to expand my community and highlight some seriously talented authors. There are countless of you out there so this is just a small sampling of what I have discovered so far…Please check them out!
1. Katie Hansen Brakeman
2. In Real Life
3. The Honest Toddler
4. The Jiggly Bits
5. What’s for Dinner Ma?
6. Learning to Hit the Curve
7. Hunting for Bliss

So…now that you know seven things about me and about seven amazing other blogs, here are the rules as I understand them from others who have received this award.
1. Thank the person who gave you the award and link back to their blog
2. Post the Versatile Blogger Award Picture on your post
3. Share seven things about yourself
4. Pass this award on to seven other blogs (Some have given it to more and sharing more love is always a good thing. Of course, this is an optional thing, so no pressure…pass it along if you wish, or just enjoy a mention. I think you’re fantastic!)

I hope you enjoy exploring the amazing community on WordPress as much as I do! Happy reading!

Chocolate Almond goodness

IMG_1909
These little nuggets of goodness are made from a recipe adapted from an inspiring and beautiful blog I have come across (thank you Caitlin-roostblog.com)  It was originally made as a dinner biscuit, but I tweeked it make it an after dinner treat. Depending on which of my adaptations you try, you can make it more like a biscuit(less sweet) or more like a true dessert….a girls got to have her chocolate right?

Over the last few months, as I have jumped, I mean seriously, like off the high dive right into the deep end of a pool (and I’m afraid of heights mind you…another wonderful bonus of getting older, but I digress) into the gluten-free realm, I have tried to nudge my family, especially the kids into the “shallow water” of gluten-free eating. So when my son, the pickiest eater of us all gives something a thumbs up, believe me, I am going to shout the recipe out to anyone willing to listen. (just turn down the volume if I’m being too loud).

I have now made this 3 ways, using either butter or coconut oil for variety. Choose whichever one sounds good to you!

Chocolate Almond Goodness: Subtle sweetness for a mini-biscuit

  • 2 1/2 cups almond flour
  • 1/2 tsp salt
  • 1/2 tsp baking soda
  • 2 eggs
  • 1/4 cup melted organic coconut oil or butter (Note: coconut oil will impart a somewhat “tropical” flavor and butter will provide a true biscuit flavoring)
  • 1/4 cup brown rice syrup
    3 Tb organic cacao powder

Preheat oven to 350F. Line a baking sheet with parchment paper or a silpat (or whatever you’ve got so things don’t stick to pan).

In a large bowl, combine the almond flour, salt, cacao and baking soda. In a medium bowl, whisk together the coconut oil, brown rice syrup and eggs. Stir the wet ingredients into the flour mixture until thoroughly combined. With a spoon or if you are willing to get dirty (which is more fun in my opinion) scoop up some dough in your hands and make small/medium blobs (very technical term) probably equivalent to 2 teaspoons or tablespoon size depending on your blob preference.

Bake for 15 minutes (give or take depending on your oven) so that a toothpick inserted into the center of a biscuit comes out clean. Let cool briefly on the baking sheet. Serve warm. ( I have also frozen the leftovers and they keep well!)

Makes about 25-28

The one below is the sweet treat version and my favorite one so far. Not too sweet, but just enough to satisfy my cravings…and hopefully yours too!

Chocolate Almond Goodness: my version of an “Almond Joy”

  • 2 1/2 cups almond flour
  • 1/2 tsp salt
  • 1/2 tsp baking soda
  • 2 eggs
  • 1/4 c organic melted organic coconut oil
  • 1/2 c organic light brown sugar
    1/4 c organic cacao powder

The mixing and cooking directions are the same as above but instead of brown rice syrup use the brown sugar and add it to your dry ingredients. Enjoy!