With summer just around the corner, Louisiana teens are gearing up for the beach by getting their “base” tans. But, many of them are unwittingly exposing themselves to the most deadly skin cancer of all – melanoma. According to the American Academy of Dermatology, melanoma is the most common form of cancer for 25 to 29-year-olds, and the second most common in teens and young adults ages 15-29. That rate is increasing faster in those most prone to tanning – girls 15 to 29 years old – than guys in the same age group. 

 

In those young golden goddess wannabes, the torso is the most common area for developing melanomas – undoubtedly due to high-risk tanning behaviors. “A lot of this is attributed to the tanning beds,” observed Dr. Adrien Stewart, a Lafayette dermatologist with over 40 years of experience. “The spray-on kind is a lot better, but for some reason, they want to get that tan.”

 

To combat this trend, the U.S. Food and Drug Administration set new guidelines for labeling sunblocks. In the past, drugstore shelves were laden with sunscreens boasting Sun Protection Factors of 60, 90 – even 100. Under the new guidelines, labels cannot list an SPF higher than 50 or 50-plus. Claims that products are waterproof, sweat-proof or offer all-day protection are now passé.

 

FDA recommends applying one ounce of sunblock to all exposed areas 30 minutes before going outside, then reapplying another ounce every one to two hours. “You’re going to use a whole bottle in one day,” Stewart noted. “But, most of us will have a whole bottle that lasts all summer, because we’re not using it right. Some people will even have some left over from last year, and so, the efficacy of it is probably gone.”

 

In Louisiana, the incidence of melanoma is prevalent because of the numerous people working outdoors in the offshore, fishing and farming industries. “People are out there 12 hours a day working in the sun,” Stewart said. “So, we have a high incidence of skin cancers in this area.”

 

Stewart has one very strong recommendation – “Avoid the sun, avoid the sun, avoid the sun.” Another is to use sunblock with the right SPF when you do go outside. “We can’t be recluses, and now, we know if we don’t get sun to help our bones, the bones go bad,” she said. “For SPF – anything from a 30 on is recommended, and one that says UVA and UVB, especially UVB, because we know that UVB is the sun-damaging part of the ultraviolet light spectrum.”

 

Psoriasis – that dreaded, incurable disease of the immune system covering victims with red, itchy, scaly plaques all over their bodies. Surprisingly, it’s more common than you think – approximately 1.5 million Americans suffer from moderate to severe plaque psoriasis. “Two out of every hundred people who walk through my door have psoriasis,” said Dr. Adrien Stewart.

 

Stewart and her partner, Dr. Robert Romero, use PUVA (Psoralen + UVA), to treat psoriasis. With PUVA, patients take oxsoralen (methoxsalen) two hours before treatment, then are exposed to ultraviolet light. The downside is that PUVA has been linked to skin cancer. “We’ve not had any cases of skin cancer in patients that we’ve treated to our knowledge, but you know, there are all kinds of inherent problems with the treatment of psoriasis.”

 

New treatments consist of biologic therapies, which use portions of the body’s natural immune system to control the disease. These include Enbrel (etanercept), Stelara (ustekinumab), Amevive (alefacept), Remicade (infliximab) and Humira (adalimumab). Of these, Enbrel, Humira and Remicade are also approved for psoriatic arthritis. 

 

Compared to PUVA, which costs approximately $1,200 to $2,000 a year, biologics can go as high as $27,000. “It is horrendously expensive,” Stewart observed. “And, of course, some of them are incredibly wonderful, but also they have more dangers attached to them. But then, you’d think that if you were covered with red, itchy plaques all over your body, maybe you’d want to try one of those.”

 

A “new age” approach to treating psoriasis is a bioactive sweet whey extract known as XP-828L. “This supposedly can reduce symptoms of mild to moderate psoriasis,” Stewart said. “I haven’t used it personally.”

 

Another reason to control this disease is the risk of developing co-morbidities. “Patients with psoriasis have a higher likelihood of developing cardiovascular disease and associated co-morbidities, including obesity, high blood pressure, type II diabetes and increased lipids in the bloodstream,” Stewart said. “Also, I read there is an independent risk factor for cardiovascular disease and heart attacks. “

 

Twenty-five to 30 percent of psoriasis patients may eventually develop psoriatic arthritis. On the horizon is a simple swab genetic test developed to assess a patient’s risk for developing PsA. The advantage to taking this test? “You might do things early that might delay or possibly prevent onset – watching weight control, exercising, taking pills that might increase calcium augmentation,” Stewart opined.

 

Lower cost and less downtime. That’s what patients are seeking in this volatile and fast-paced world. And, Louisiana’s dermatologists are right on target.

 

For resurfacing the skin, the latest technique is the fractionated Co2 laser. Unlike prior Co2 lasers, which treated the entire skin surface, fractional lasers treat a zone of skin next to a zone of untreated skin. “What that has allowed us to do is get the same results we used to get with full-face laser resurfacing, but without the downtime and the side effects that we were having to deal with,” said Dr. William Trent Massengale of the Dermatology Clinic in Baton Rouge.

 

Typically, patients have about two to three weeks of downtime with the Co2 laser, along with side effects such as scarring and wound infections. Fractional resurfacing cuts that downtime to about one week. “It gives us the ability to fractionate the laser and not treat 100 percent of the skin, but a certain percentage or fraction,” Massengale explains. “And, the doctor can actually alter what percentage of the skin you would like to treat, depending on whatever the results or goals are.”

 

Another advancement in cosmetic dermatology is the use of digital photography. Using computerized analysis along with digital photography allows physicians to give patients an objective picture of their results. “So, no longer are we saying the subjective, ‘I think you look better, or ‘I think you look 50 percent better,’” Massengale reported. “With this, we are able to give somebody an exact percentage of improvement.”

 

The Dermatology Clinic uses the VISIA-CR, manufactured by Canfield, for its digital photography. This system standardizes facial photos from the lighting to the camera position, allowing patients to really see the difference in before and after pictures. For instance, the computer analysis can compare a 50-year old Caucasian patient’s face to other 50-year-old women in the U.S. “You can get percentile ranking on everything from brown spots to pore sizes to red spots to wrinkles to texture,” Massengale explained. “So, we are able to actually show how much patients have improved with just one treatment.”

In the world of facial rejuvenation, the use of fillers has blossomed. While Botox is still the number one cosmetic procedure performed at the Dermatology Clinic, fillers are rapidly becoming the second. These facial plumpers are less expensive and invasive than the surgical facelift. One of the primary ways of restoring a more youthful appearance is mid-facial volume correction with fillers to the cheeks and temple areas. “As you get older, your cheek fat pads begin to migrate downward with gravity, creating deep folds called the parentheses,” Massengale explained. “We are able to restore that cheek volume and give patients a lift and fullness without the knife. So, people are able to put off the face lift, and then it’s less expensive.”

 

Veteran dermatologist Dr. Adrien Stewart thinks that these new procedures are terrific. “Why not?” she said. “If you have frown lines, why wouldn’t you go get a shot of Botox and reduce the frown lines? As long as they’re not proven to be harmful, I think they’re wonderful. People look better, they feel better about themselves. I don’t see anything wrong with it at all. You are getting firsthand what is best for your skin. Why not do it?”

 

With today’s economy, some non-specialists are investing in these new lasers and fillers. But, Massengale cautions that there are drawbacks. “Before going to a weekend course in Las Vegas sponsored by the laser company, you might want to think about the increased liability for your practice,” he warned. “You are held to the same standard as dermatologists or plastic surgeons at the medical review panel level. You might want to think twice about investing in that laser just to make more money.”