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!

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Mirror, mirror on the wall

photo credit: oocities.com

photo credit: oocities.com

Who’s the fairest of them all?  Fair, pale, au natural…..even fairy tales love sun-protected skin. I know, I know, that’s not what the Queen had in mind, but this is my story now so indulge me. What was the Queen longing to see when she looked in the mirror? She desired a youthful appearance, like that of Snow White, with a face free of wrinkles, brown spots, dilated pores and blood vessels. I know that’s what I long to see when I look in the mirror, how about you?

Unfortunately, despite my career choice to nurture and protect skin as a dermatologist, as a kid and teenager I was not a skin nurturer, in fact, I was a down-right skin-abuser. I burned, fried and tanned my skin any chance I could get. My sister and I would have contests to see how long we could lay out in the sun before we nearly passed out from heat exhaustion or play the game of “how low can you go” with the SPF factor on our “suntan oil.” Yes, oiling our hide to tan it was the object of the game. Thankfully we quit playing before our hide became leather…. but barely. Instead of leather, I got lots of freckles and moles (a direct correlation of sun-damage), many of which have been biopsied and been proven to be atypical histopathologically. In essence, I am my own skin nightmare with scars all over my body as a constant reminder that I’m not dreaming.

Premature wrinkling, sagging skin, freckles, dilated facial blood vessels and brown spots are manifestations of sun-damage which is referred to as photo-aging or if you want to be fancy, dermatoheliosis. Compared to physiologic (chronologic) aging, the changes seen with photo-aging are accelerated with the end result of having you looking significantly older than your stated age. Sure, as teenagers some of us wanted to look older so we could get into establishments with age restrictions, but as adults I think many of us are thrilled when someone mistakes you for someone’s “younger sibling.” Maintaining a youthful appearance is the reason the cosmetic/aesthetic procedure industries have exploded in recent years with new products and innovations.

The good news is that you don’t have to spend a fortune to maintain your youthful looks! Just a few minor adjustments to your daily routine will help you minimize the damaging effects of the sun on your skin. Daily use of sunscreen, either in your moisturizer, after-shave cream or make-up is a simple way to layer on your sun protection on all your exposed skin. It’s the UVA rays which are the “aging” rays, so make sure the products you buy are labeled “broad-spectrum” so that you get coverage for both UVA and UVB (the burning rays). Remember, UVA rays can penetrate window glass, so while you are driving in your car and sitting by your office window you are still get “sun.” If you have ever noticed that the left side of your face and left arm have more spots and lines on them, this is one of the big reasons as your left side gets bombarded by UVA rays while you are driving. The recommendation is to use products that are SPF (sun protection factor) 15 or higher and I like to use SPF 30 in my daily moisturizer. Choosing products that have zinc oxide and titanium dioxide will minimize irritation for those of you with sensitive skin. There has been much controversy over nano-sized particles of these ingredients, although the research is still ongoing, there are plenty of fantastic products currently on the market that do not use nano-sized particles. Remember, whichever products you choose to use, sunscreens regardless of SPF or active ingredient will break down approximately 2 hours after application, so if you are planning on being outdoors for an extended period of time you need to reapply. There’s no reason you can’t look good while maintaining your youthful appearance right? So wear some fashionable sun-protective clothing (check back with me soon for a preview), a broad-brimmed hat, and don some shades to protect those eyes because ocular melanoma is challenge to treat so prevention is key.

Mirror, mirror on the wall who’s the fairest and most youthful looking of all? My sun-protected shaded bliss fans of course! See you in the shade!

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!

Like a fine wine…..

photo credit: www.trialx.com photo credit: http://www.trialx.com
We have heard the cliché countless times, “Aged like a fine wine.” But what does that really mean? What makes a wine so fine (aside from my rhyming ability)? As with many things, success is achieved through collaboration of multiple factors to produce a better end product. The same principle applies to winemaking. The creation of a fine wine rests upon factors including the varietal of grapes used, the light, temperature and soil conditions affecting the grapes and vines respectively, the length of the fermentation process and yes, you guessed it (this is a dermatology blog after all) the skin. Wine grapes, compared to table grapes, have a thicker skin; a desirable quality as the skin imparts the aroma to wine. Grape skin also contain tannins which produce the color of the wine. These tannins found in the skin help to preserve the wine for a longer period. Recently, it has been found that the skin of black grapes (used to make red wine, a personal favorite) contain a chemical called resveratrol; which is what provides the cardio and chemo-protective health benefits of red wine.

For those of you who love wine, these tidbits are good fodder to keep drinking, yes? Salut! But the point of all this information is not really about wine of course. It’s about skin. Your skin. Like the creation of a fine wine, the health of your skin is a significant contributing factor to the end product of your overall well-being.

Your skin is the largest organ of your body. As such, it is constantly exposed to the elements just like wine grapes, and light, in the form of UV-rays have a significant impact on the quality and appearance of your skin and your health. With regards to appearance, prolonged exposure to UV-radiation directly affects the color and texture of your skin. The acute changes may be a sunburn, followed by a tanned appearance. But what about the chronic changes? Those brown spots on your arms and hands that folks refer to as “liver spots” or “age spots” are in actuality the manifestations of chronic sun exposure and resultant sun-damage. They are irreversible.

For a grape, dried by the sun, the texture and quality of the skin transforms to a wrinkled, flaccid and shriveled form which we call a raisin. Our skin is very similar to the grape. Premature wrinkling, loss of elasticity and leathery feel to the skin (think Magda from “There’s something about Mary”) are direct by-products of extensive sun-exposure. So which would you rather be, a grape or a raisin? In a society where people are paying a premium for a youthful appearance with products like Botox, dermal fillers and plastic surgery, why not save money and be pro-active: protect your skin from the sun everyday!

With regards to health, it is known that UV-radiation suppresses the immune system. Suppression of the immune system leads to cancer. It has been reported that 90% of skin cancers are induced by UV-radiation exposure. 90%! This statistic is a vital reason that I encourage you to seek shade (where your bliss awaits), wear sunscreen and protective clothing on a daily basis.

Now some of you may be thinking, what? How can that be? Maybe Dr. Barr (that’s me) has been drinking too much of that red wine, because I know that phototherapy (delivery of UVB rays in a very controlled and time limited setting) make my psoriasis better! Psoriasis (a chronic skin condition +/- joint involvement) is known to be driven by an up-regulation of aspects of the immune system…so suppression of these “jazzed up” factors so to speak, is the desired end result. This principle applies to several conditions in dermatology, but these are the exceptions not the rule, and most importantly, the exposure to UV-radiation administered in a dermatologist’s office is tightly regulated and controlled to minimize adverse effects of said exposure.

Like a fine wine, your skin will age, but there’s a big difference between chronologic aging and physiologic aging. The latter of which is accelerated significantly by extensive sun-exposure. So the choice is yours, grape or raisin…which would you rather be?

What’s the big deal?

IMG_1934

Skin cancer is a big deal. More than 3.5 million cases of nonmelanoma skin cancer in over two million people and over 70,000 cases of melanoma are reported each year, which makes skin cancer the most commonly diagnosed cancer the United States. This means that on an annual basis there are more new cases of skin cancer than the incidence of cancers of the breast, prostate, lung and colon combined. To break this down further, one in five Americans (one in three Caucasians) will develop skin cancer during the course of a lifetime. Bottom line…skin cancer is a big deal. In my skin cancer and sun safety basics post I go over a lot of the facts, so please refer back to it for a more in-depth discussion, and please feel free to reach out if you have any questions. Also check out skincancer.org for a wealth of great information and photos of all of the different types of skin cancers.

So if I already talked about these facts in a previous post, why am I all riled up and repeating myself you might ask? Contrary to what my kids may say (and my husband and possibly the neighbors, but who likes nosy neighbors anyway?) I have not lost my mind, but my mind is most certainly boggled. A recent study reported that greater than 27% of melanoma survivors never put on sunscreen when spending more than an hour in the sun. Researchers at Yale also found that 15.4% of skin cancer survivors rarely or never sought shade from the sun, and 2.1% used tanning beds. This is insanity. Tanning beds? Evidence from several studies has shown that exposure to UV radiation from indoor tanning beds is linked with an increased risk of melanoma, the deadliest form of skin cancer, and non-melanoma skin cancer. In fact, studies have demonstrated a 75 percent increase in the risk of melanoma in those who have been exposed to UV radiation from indoor tanning. 75 percent! This evidence is the basis for championing the passage of legislation to ban the use of tanning beds for minors (currently 33 states have restricted teen’s access to tanning beds). So if these are the facts, and people who have already been diagnosed with skin cancer have been educated about these facts, and believe me, as dermatologists we tell our patients, over and over again, then why are skin cancer patients still ignoring them? This is a dilemma. This is my dilemma and I want to help change these statistics. But I need your help to do it.

We know that protecting your skin from the damaging UVA and UVB rays of the sun is imperative to minimizing your risk of developing skin cancer. Sun protection is a multi-faceted process: practicing sun avoidance during the hottest parts of the day, seeking shade (I promise you can find bliss there), wearing sunscreen (daily and reapplying often) and wearing clothing that has a UPF rating greater than 30, are all important to keeping you safe in the sun.

Based on the staggering number of skin cancers diagnosed annually and the results of the recent study noted above, it would appear that telling people this information isn’t enough. It would appear that a cultural shift, a “shade revolution” if you will, is in order. For starters, we need to embrace vintage times, go retro…what’s old is new again. It works for current fashion trends (hello neon and leg warmers!) and toys (yes, cabbage patch kids I’m talking about you!) so why can’t we embrace the way we used to behave in the sun. Back in the day our ancestors spent plenty of time outdoors, but clothing protected the majority of their body. Being pale was in vogue, whereas having a tan was undesirable. We can do this! You don’t have to give up that Caribbean vacation or frolic on the beach, just be sun savvy! Tap into your sun-conscious and take the necessary steps to protect your skin. Together we can change the perception of what’s “hot” in the sun and you will find your shaded bliss, I promise!