Dr. Joel Schlessinger

The American Psychological Association recently published an article titled “The link between skin and psychology,” which focuses on the relationship between psychological and dermatological problems. The field of study, called psychodermatology, embraces the idea that common skin conditions are affected by psychological issues. In this blog, Dr. Joel Schlessinger sheds light on this idea and why we shouldn’t always blame skin conditions on stress or other psychological factors.

It’s difficult to prove skin conditions are caused by stress, Dr. Joel Schlessinger explains.

According to the APA, psychodermatology focuses on “skin problems affected by stress or other emotional states, psychological problems caused by disfiguring skin disorders, and psychiatric disorders that manifest themselves via the skin, such as delusional parasitosis.” Psychodermatology is common in Europe but not as commonly noted in the United States.

“I think this is a really easy thing for some doctors to blame skin conditions on stress, but stress is very difficult to prove as a cause as it is nearly impossible to reproduce or quantify,” Dr. Joel Schlessinger says. “Therefore, the onus of improving the disease is placed onto the patient (‘You are causing your disease’), rather than the physician. That doesn’t seem fair to me and would only serve to increase a patient’s stress level.”

Dermatologists should holistically treat skin conditions, says Dr. Joel Schlessinger.

Even if stress does play a role in worsening skin conditions, Dr. Joel Schlessinger says patients shouldn’t have to treat themselves. Instead, he prefers to do what he can as a dermatologist to treat their concerns using more traditional methods in combination with other natural and environmental factors being addressed when necessary.

“Stress is something that is part of everyone’s life and while we all try to be care-free, we can’t be in most cases,” he says. “Therefore, I would rather try to focus on what I can change as a dermatologist and avoid throwing salt on the wound by insisting on a daunting task for my patients in order to treat their condition. This doesn’t mean that we shouldn’t try to be as stressful as possible and work on improving it when we can, along with other natural and holistic treatments, however.”

Do you have a question for Dr. Joel Schlessinger? Let us know in the comments.

Probably the most interesting of all the movies I saw this awards’ season was Boyhood. Not only does it have a compelling premise around the growth and development of the main character over 11 years, but it shows the aging of the other characters over the same period.

My career as a dermatologist puts me in a position to stall the effects of aging in many of my patients who desire services such as Botox, fillers, lasers and more. While we see aging in this movie in the mother and father (Patricia Arquette and Ethan Hawke), do they seem to age normally or are they doing their best to stop the clock?

My thoughts are that Hawke is not doing anything to stall the effects of aging, whereas Arquette is almost certainly undergoing treatments such as fillers and neurotoxins. The changes on Hawke’s face are significant but due to normal activities like frowning. Similar to a piece of paper that is folded hundreds of times will ultimately retain a crease, the human face will also respond to repeated activities over time.

Hawke develops a crease in the middle of his forehead (glabella) over the course of the movie. Presently, he is 44 years old and shows definite signs of aging, perhaps more than his chronological age should show. With some very simple interventions, he could regain his youthful appearance. For example, just a little Botox or Dysport and filler, such as Restylane or Juvederm, could improve the mid-forehead crease. And he also seems to be a little gaunt, which could easily be improved with fillers such as Voluma in the mid-cheek area.

Lastly, EltaMD sunscreen would help with the Hawke’s noticeable sun damage. Being raised in Texas, Hawke most likely experienced quite a bit of sun growing up and this hasn’t helped him. It takes about 20 years for the effects of sun exposure to show up. We are now just seeing the results of sun exposure in his 20’s, so it may be rough over the next few years if he hasn’t ever protected himself. Additionally, if he is a smoker, smoking could complicate matters by contributing to premature aging.

As for Arquette, it seems she has done everything she can to keep her skin healthy. Her complexion is alabaster throughout the majority of the film and that is going to help prolong the excellent appearance of her skin and keep her looking youthful. It does appear that she is probably no stranger to the dermatologist, as she appears to have some fillers in her cheeks and minimal, if any, developing frown lines.

While many actresses let their wrinkles show up when they appear in movies lest they look ‘done’, my guess is that she is being treated with neurotoxins such as Botox, as she has little or no signs of aging. She does have some wrinkles around her eyes, which are also treatable with Botox, but they are very minimal. In short, Arquette is doing the sorts of things that will continue to keep her looking good for many years and as long as she stays out of the sun and doesn’t go overboard with treatments (something which is important and rests not only in her hands, but in the hands of her dermatologist), she will do just fine.

Whether or not the lack or presence of cosmetic surgery among the ‘parental’ cast of Boyhood will influence the award’s season decisions is not something I can say, but the fact that neither headliner in this movie did anything too drastic to their faces during the time of the shoot was helpful in portraying a relatively realistic aging sequence.

Piercings are a common accessory for both teens and adults. Earlobe piercings often heal without problems, but body piercings are a different story. These piercings are more risky and can result in infections even if they are done properly. Dr. Joel Schlessinger explains the pitfalls of body piercing.

Piercings in areas with significant bacteria can become infected, explains Dr. Joel Schlessinger.

Infection is a common concern for new and even older piercings. Pierced skin leaves an open wound that is vulnerable to contamination. The upper areas of the ears and the nose, both common spots for piercings, are made up of cartilage. These areas are often harder to clean, take longer to heal and are more likely to become infected at any time after a piercing. Additionally, clothing can trap dirt and other activities can lead to infections. Serious infections often require the piercing to be removed and can even lead to loss of an ear or nasal deformity if severe. Once removed, the piercing may cause scarring.

If you do decide to get a piercing, make sure the person doing the piercing is an experienced professional, Dr. Joel Schlessinger says.

To minimize the risk of infection and other complications, always see a reputable and trained professional for piercings. The challenge with this is that there aren’t any serious regulations on body piercing and you could have one done in a mall or by a person with zero experience or talent. The area should be cleaned with alcohol very carefully before the piercing is done. The person who is doing the piercing should be wearing gloves and professionally trained on equipment and procedures.  Sadly, there is no way to assure this other than by word of mouth.

Try to make sure the environment and equipment have been sterilized. Without sterilization, there is a risk of spreading diseases such as hepatitis B, hepatitis C or HIV. Blood infections, or sepsis, can also occur if the person doesn’t use a sterile technique. If you have doubts about the cleanliness of the environment, leave immediately.

Problems with the type of jewelry can also be an issue, specifically if you have metal allergies. Make sure the jewelry used is hypoallergenic and the item is designed to be used with your specific piercing. Don’t remove the jewelry while the area is healing as this can cause more irritation.

Dr. Joel Schlessinger shares how important it is to care for your skin if you do decide to get a new piercing.

If you do decide to get a piercing (whichever area you choose), proper hygiene is essential to avoid infection and other complications. Gently clean the skin around the piercing twice a day using a cotton ball or pad dipped in rubbing alcohol to disinfect the area and prevent scabbing. If the piercing site becomes very tender or red, it’s important to see a board-certified dermatologist as these could be signs of an infection.

Do you have a question for Dr. Joel Schlessinger? Share with us in the comments.

The birthmark, a ‘port-wine stain’, that is seen on Agatha’s (Saoirse Ronan) face in the “Grand Budapest Hotel” affords a huge opportunity for The Dermies to explain a condition that many dermatologists see and treat routinely, although it occurs in less than 1% of the population. I would like to think that this is one of the reasons this movie has been acclaimed during the awards season.

Port-wine stains are usually noted at birth as a flat pink mark on the face. Generally, they follow one of three distributions on the face in a pattern on the upper, middle or lower third of the face and on either the left or right side, but not on both. Over time they can become larger and often develop bumps or larger nodules that occasionally bleed. The port-wine stain in this film is slightly less noticeable than many we tend to see in persons the age of the actress in this film. Ms. Ronan doesn’t have a birthmark in real life, so the producers of the film intended to present it to audiences. The most noticeable person in recent times who brought attention to this mark was Mikhail Gorbachev, the leader of the Soviet Union from 1988 to 1991.

Many different lasers have been used over time in treatment of port-wine stains, pulse dye lasers and intense pulsed light devices most recently, and have generally been successful in diminishing them. Treatments are usually started early in life, with multiple treatments necessary to result in significant improvement. Some affected people have also used makeup, such as Dermablend that can effectively cover up the birthmark.

I was impressed with the portrayal and treatment of Agatha’s birthmark in the movie. Additionally, I was delighted to see that her beauty was a central factor of the movie, notwithstanding her birthmark. While I treat many birthmarks for patients who desire modification, it often strikes me that these are beautiful people whose birthmark accents their beauty, rather than detracting from it. Sadly, childhood isn’t easy for many of my patients with birthmarks or other, more common, conditions such as acne, and treatment does appear to be the rule rather than the exception because of the negative notice engendered by a birthmark.

While I wouldn’t bestow The Dermie for Best Picture on Grand Budapest Hotel, I do feel the movie deserves applause for allowing its heroine to display one of the more common birthmarks and introduce this to film audiences.

Acne scarring of any kind can serve as a painful reminder of previous breakouts, and it can distract from otherwise healthy skin. Pitted scars, also known as depressed scars, come in many shapes and sizes. These scars are characterized by narrow, round or boxy depressions in the skin, and they often occur in clusters or patches. Pitted scars form when excessive inflammation occurs, causing a break in the follicle wall. The deeper the inflammation, the more likely there will be tissue loss, and a visible depression left behind on the skin.

Consult with a board-certified dermatologist like Dr. Joel Schlessinger about scar treatment.

Pitted acne scarring will not fade away on its own. In order to successfully minimize its appearance, you will need to consult with an experienced, board-certified dermatologist to help determine the best course of treatment. Though there are no over-the-counter or prescription topical treatments known to effectively reduce the appearance of pitted scarring long-term, there are several professional procedures that can make a significant improvement.

Dr. Joel Schlessinger recommends the Fraxel laser resurfacing treatment to help minimize acne scarring.

CO2 laser resurfacing has long been regarded as the gold standard for effectively treating a variety of skin concerns, including fine lines, hyperpigmentation and scars. More recently, new developments in laser technology have made this option even safer for the treatment of acne scars.

Fraxel is a semi-ablative procedure that is founded on the skin’s natural healing processes. During the procedure, microscopic laser wounds are spaced evenly across the skin to help stimulate renewal and repair. This jumpstarts the production of healthy collagen so that instead of experiencing immediate results, Fraxel allows skin to continue to rejuvenate and improve in tone and texture over a period of about six months. Fraxel laser resurfacing also features a new delivery system that helps the laser’s tiny microbeams penetrate the skin while leaving healthy tissue behind. With healthy tissue intact, the healing process is expedited, and usually only one session is needed to produce visible results.

The best way to avoid pitted acne scars is to treat acne early on, says Dr. Joel Schlessinger.

Even with advanced treatments like Fraxel, the results are not permanent, and there is no way to completely eradicate the appearance of deep pitted scars. The best way to avoid pitted acne scarring is to seek professional treatment for acne early, usually as a pre-teen or teen when the initial mild to moderate breakouts appear.

Do you have a question for Dr. Schlessinger about treating pitted acne scars? Let us know in the comments section.

While I wanted to start out with a movie for The Dermies that was nominated for Best Picture, I had to begin with Wild. This movie was nominated in the category of Best Actress (Reese Witherspoon) and in the category of Best Supporting Actress (Laura Dern). There were just too many great dermatologic aspects of this movie to not put it first, although there are other movies that I will review that also are a dermatologist’s dream.

In this movie, Witherspoon plays the part of Cheryl Strayed, who hikes more than 1,000 miles on the Pacific Crest Trail. The movie was incredible, but as a dermatologist, I found myself worrying about Cheryl’s skin. She doesn’t appear to apply sunscreen during the movie. Granted, the movie takes place in 1995 and sunscreens weren’t as good at that time as they are now, but still it would have been helpful for her future skin had she applied sunscreen every 2-3 hours. Carrying sunscreen would have increased the heavy load she was carrying, but from my standpoint, it would have been worth it. I hiked Mt. Kilimanjaro and Mt. Rainier, and I can assure you, EltaMD sunscreen was in my backpack at all times.

The good news is that there are now clothes with UPF (a form of sun protection) that Cheryl could have worn and wouldn’t have increased her load. Also, Cheryl didn’t wear a hat or sunglasses. This raises a dermatology warning flag as hats are essential coverage and ocular melanoma can result from poor eye protection.

There are many other fascinating dermatology aspects about this movie, ranging from blisters on the feet and hands, to bruises from the hike. There was also a particularly awful case of boot toe in the beginning, with a toenail that Cheryl removed due to ill-fitting boots. The nail probably should have not been removed as the strong keratin in the nail protects the underside and without a nail, there is zero protection. Instead, I would’ve liked to see her take duct tape and wrap her toe. As for the blisters, Cheryl doesn’t seem to have any moleskin with her, and it is always a great idea to take moleskin along when you hike.

As I watched it, I kept thinking about FixMySkin 1% Hydrocortisone Balm, the product that my son and I invented in 2010. Had this product been around it during the time, it would have been fantastic for Cheryl to use on her abraded and dry skin. She could have even put it in her pocket and saved weight in her pack.

During the movie, Cheryl gets a tattoo of a horse on her arm to match her soon-to-be divorced husband’s tattoo. This is an unusual thing for me to see, as most of the time tattoos for an ex-husband or ex-wife are ones that I am lasering off. In the case of this tattoo, it would be very easy to laser off as it is predominantly one color. If the tattoo was green, it would be much harder to remove.

Cheryl does many risky things in this movie, including recreational drug use, casual sex, and, of course, a presumed lack of sunscreen. However, it is important to point out that tattoos are also risky. The needles can be contaminated and they have a potential to transmit hepatitis.

At one point in the movie, Cheryl comes to a town and wanders into a beauty store. She is carrying a massive backpack with all of her camping gear. She looks into a mirror and applies some very red lipstick. She seems pleased with how she looks until the salesperson approaches Cheryl and realizes she is very dirty and fatigued. She mentions to Cheryl how important it is for a woman to be aware of her skin and personal hygiene, but she doesn’t offer to help her buy the lipstick or anything else in the store. Cheryl mentions that she is definitely working on her personal hygiene and leaves the store.

While I was shocked at how rudely the salesperson spoke to Cheryl, I was also shocked that she applied the lipstick from the sample. That it is something that we don’t do in our store, LovelySkin, as it can lead to the transmission of viruses and colds. Instead, we use a cotton bud to spread lipstick. Our staff would throw away the lipstick if they saw something like this happen in our store.

In another scene, Cheryl is at a camping site where a worker is trying to help her lessen her backpack load for her journey. The first thing the worker notices her deodorant. She decides to toss the deodorant and makes a comment that her underarm smell is the least of her bodily worries. Although deodorant may not be important to Cheryl, I do believe antiperspirants should play a huge role in most people’s regimens.

Although it seems that Cheryl spends a lot of time under sun exposure, especially in the Mojave Desert where the movie begins, Cheryl’s skin doesn’t tan. This probably means that she did wear sunscreen or that she used some sort of sun protection while hiking. I think her chances for the Best Actress award are very good as she was clever to protect her skin under extreme exposure, and of course, Reese Witherspoon is a superb actress! My vote for the Dermies Best Actress goes to Reese Witherspoon for her beautiful skin and great portrayal of Cheryl Strayed in Wild.

By Dr. Joel Schlessinger

It’s award season for the movies that we know and love. As a dermatologist, I have always felt there should be a special award for movies that portray the skin and beauty-related issues in a positive manner since this leads to better skin health and a focus on better skin care.

The Dermies have been created as an award for movies and other cultural offerings that celebrate beauty in a relatable manner and help inform the public about issues and procedures in a health-conscious way. I hope my audience finds these awards and my commentary entertaining and helpful!

There is a common myth in skin care that starting a new treatment or regimen leads to skin purging. The idea is that when you start a new skin care treatment, breakouts are a good sign because your skin is purging itself of impurities. But is there any truth behind this myth? Read on to find out.

Your skin can react to any change in your daily routine, Joel Schlessinger MD explains.

When your skin reacts to a new product, it’s not purging itself of impurities. In fact, it’s the skin’s job to keep things out, not detoxify the body. Any reaction you’re seeing to a new product is the skin naturally trying to restore balance. This can happen whenever you make a change to your skin care routine.

Another explanation could be that you’re having a reaction to the ingredients in the products. Products that contain alcohol, fragrance or other additives can sometimes cause irritation. Additionally, if you’re using products with too many active ingredients, this can cause skin to become overly sensitive. The products in your skin care routine should work together to improve your skin.

Joel Schlessinger MD says it’s important to determine what caused the reaction and adjust accordingly.

If you notice a sudden breakout or increased sensitivity, stop using any new products and see if the reaction clears. Once your skin calms down, you can slowly add products back into your routine. Try only applying formulas every other day or alternating treatments in the morning and the evening. If the reaction persists, it’s time to see a dermatologist.

Do you have a question for Joel Schlessinger MD? Share with us in the comments.