System Check: Insights on the Skin/Body Connection

From diagnosis to treatment, there are always new revelations about the skin’s connection to the body’s other systems.


Melasma: Oral Agent on the Horizon

“Tranexamic acid is recently being studied to look at treatment of melasma, as well. And it has a lot of efficacy in treating various pathogenetic components of melasma. It helps not only with melanogenesis, but it helps target the hormonal and vascular components of melasma, as well.”

— Nada Elbuluk, MD

Clinical Clues to CTLC

“One of the main clues [to CTCL] is an eruption that is not responsive to conventional therapies. The patient may have had it for a decade; So no response to therapy like topical steroids—you’d expect eczema at least to partially respond. These are conditions that are just non-responsive. They’re chronic…It’s a condition that tends to occur in areas that are sun-protected. You can look for the classic areas around the buttocks, the axilla, and groin. It’s a condition that is probably not going to occur very frequently on the sun-exposed arms or the face.

Those are clues: chronicity, lack of response to therapy, and that nuance that it occurs in sun-protected areas.”

— L. Frank Glass, MD

Dermatologists’ Role in Diagnosing PCOS

“I’m a medical dermatologist, and one of the things that really drew me into medical dermatology is my interest in looking into skin science and what that tells us about a person’s overall health.

PCOS is one of the most common endocrine conditions in women, and it has many skin manifestations…In fact, a woman with PCOS is very likely to see a dermatologist as the healthcare provider when she presents for medical care. One in four women with PCOS will present to a dermatologist first…

When we looked at a very large cohort of women with PCOS—one of the largest cohorts of women with PCOS in the world—we discovered that things like acne are not that helpful in identifying women with PCOS…Rather, things like hirsutism, excess hair growth, as well as acanthosis nigricans…should be triggering us to work that patient up.”

— Kanade Shinkai, MD, PhD

Plant to Bedside Approaches with Cannabinoids

“At least from an RX perspective, we don’t have anything yet, but that’s not to say it’s not going to change relatively soon. From a systemic perspective, I’m proud to say as residency director that one of my residents just published a paper looking at ajulemic acid, one of these synthetic cannabinoids, in vitro…that can have a profound effect on peripheral blood immune cells from dermatomyositis patients in reducing inflammatory mediators.”

—Adam J. Friedman, MD

Skin: Outside In/Inside Out

“Chemical peels are having a bit of a renaissance, and they’re a great way to bridge between the procedures you’re doing in your office and also between getting people back in…this is a way to keep patients engaged and give them the best possible outcome.

Nutraceuticals is something I am seeing a ton of in my office…I have not seen one young patient come in and not ask me about collagen. Everyone is wanting to do oral collagen.”

—Erin Gilbert, MD, PhD

“When we look at some of the statistics out there, this idea of surgical nutrition has really been a hot topic, because the hospital studies have shown that sometimes over 50 percent of patients undergoing surgery are actually undernourished or malnourished when they’re getting their procedures. That can really compromise healing. What we decided to do is create a cosmetic surgery package in that it’s a nutritional supplement to optimize the body and the skin for proper healing.

Patients are spending, especially in the cosmetic surgery world, lots of money on their procedures. Why wouldn’t patients want to make sure they protect their investment and spend a little bit extra in order to optimize their healing, so they get the best outcomes?”

—Jason Bloom, MD


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Ali Kinnie
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About Practical Dermatology

Practical Dermatology is the monthly publication that provides coverage of medical care, cosmetic advancements, and practice management for clinicians in the field. With straight-forward, how-to advice from experts in various fields, we strive to enhance quality of care and improve the daily operation of dermatology practices.