Fully Exposed


Posted on: February 02, 2015

Millions of Americans will take to the outdoors this winter. The health benefits of winter sports are numerous. The release of endorphins elevate mood and help ward off "cabin fever." Engaging in winter sports burns more calories than equivalent warm weather activites as it takes more energy for the body to maintain its body temperature in colder environments. But exposure to cold temperature, wind and wet weather may lead to freezing of the skin and underlying tissues, a condition called "frostbite."

Frostnip, the mildest form of frostbite, most often affects the face, nose, ears, fingertips and toes. It presents with numbness and a bluish or whitish skin color for a short period of time. After re-warming, normal skin color returns and the numbness resolves. Frostnip does not leave any permanent damage.

Deeper forms of frostbite may turn the skin red and blue. The skin may feel hard and swelling of the affected area often ensues. Fluid filled blisters commonly appear and with more severe cold injury, blisters may fill with blood. Stinging, throbbing, and burning can occur and discomfort with re-warming of the skin is not uncommon.

Full thickness frostbite is a very serious condition as damage to the skin is accompanied by cold injury to underlying muscles, tendons, and bone. This often leads to permanent loss of tissue, nerve damage and infection.

Prevent frostbite. Limit the time spent oudoors in cold, wet or windy conditions. Wear layered clothing as air trapped between the layers act as an insulator against the cold. Wear waterproof and windproof gear to protect against wind, snow and rain. Remove wet clothing as soon as possible. Wear protective headgear that covers the ears and wear mittens (which provide better protection than gloves.) Stay hydrated and eat a healthy meal before going out in the cold. Avoid alcoholic beverages.

All forms of frostbite require medical attention except frostnip, which can usually be treated at home by re-warming frostbitten areas in warm water soaks (99-107 F) for about 20 minutes. Remove any jewelry, especially rings on fingers, that could tighten as swelling develops. Avoid further cold exposure. Over-the-counter anti-inflammatory medication like Advil or Motrin may be beneficial for throbbing or discomfort.

Seek medical attention if:

  • Skin appears white or pale.
  • Numbness or blistering occurs.
  • Pain, swelling or redness of the affected area develops.
  • Fever occurs.
  • Or other new unexplained symptom develops.



Posted on: December 29, 2014

Cracked heels, also known as heel fissures, are experienced by over 20% of US adults over age 21. More common in women than men, this condition is often nothing more than a cosmetic nuisance. Deep "heel fissures" however, can develop and be quite painful. In rare cases, heel fissures may lead to infection.

This condition is generally caused by dry callused skin around the rim of the heel. Prolonged standing (especially on hard floors), obesity (due to an increase in pressure exerted on the fat pad in the heel), and open backed shoes or sandals can exacerbate the condition. Certain medical conditions can also predispose people to dry skin and cracked heels. Neuropathy (associated with diabetes), psoriasis, eczema, and fungal infections are just a few of the conditions that can lead to skin dryness and increase the likehood of heel cracking.

The best treatment for cracked heels is prevention. Feet should be moisturized after showering with therapeutic emollients. Once dry heels develop, moisturizers containing humectants (water absorbing compounds like urea or lactic acid) applied twice daily may improve the condition. In addition, alpha hydroxy acid creams may help with exfoliation. Occlusive based moisturizers, like Petrolatum, applied at bedtime may soften calluses and help repair skin dryness and heel cracking. After showering, when the skin is soft, the use of a pumice stone, prior to moisturizing, to gently remove dry skin and callus may be beneficial. Deep fissures should be covered with antibacterial ointment to prevent infection.

Seek immediate medical attention should pain, redness, bleeding or swelling develop.

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Posted on: November 06, 2014

Spider veins are those small weblike networks of red, purple and blue vessels that are easily visible through the skin and found most commonly on the legs and ankles. Women are more susceptible than men to develop them and those with blood relatives with spider veins are more predisposed to developing these roadmap veins.  Heredity seems to play an important role in the development of spider veins. There is little scientific evidence that crossing the legs causes spider veins.

Spider veins are usually painless and are more of a cosmetic concern for most but rarely can cause a dull ache or burning sensation, especially after standing on one's feet for prolonged periods of time.

Although laser light therapy is an option for spider veins, sclerotherapy, a proven procedure that has been performed since the 1930's, is still considered the gold standard treatment for spider veins on the legs and ankles.  With a very fine needle, the small veins are injected with a sclerosing agent (usually a salt solution) that irritates and eventually scars the inside lumen of the veins causing them to fade from view.  More than one treatment is often necessary but this procedure is usually quite effective.  Sclerotherapy can be done in the doctor's office with each treatment taking approximately 15-30 minutes.  Side effects include localized swelling, itching, skin color changes that usually fade with time, and rarely skin ulceration. The development of new tiny vessels may occur at injection sites but often fade after several months.

Because the exact cause of spider veins is unknown, they cannot always be prevented. Try to maintain a healthy weight and stay physically fit.

Spider veins are not harmful to overall health, but, if self conscious about them, see a dermatologist for possible therapy options.



Posted on: October 20, 2014

Hangnails are not nails at all, but little triangular pieces of skin at the edge of a fingernail that occassionally bleed and, are often, quite irritating. They are more common in the winter due to dry skin from the cold winter air but harsh chemicals, nail biting, and excessive hand washing can also cause the development of hangnails. If not properly cared for, hangnails can be the site at which bacteria enters the skin and causes an infection around the nail cuticle.

PREVENTION: Since dry skin is the primary cause of hangnails, moisturize the hands and nail beds several times a day to prevent hangnail development. If you are nail biter, QUIT! 

TREATMENT: If you get a hangnail, don't rip it off!  It'll hurt. Secondly, the site may become more inflamed and more painful. And thirdly, a larger skin wound may result.

  • Cut off the hanging skin with a clean nail clipper or small nail scissor.
  • Wash your hands with water and a mild soap free cleanser and apply a hand cream to the site.
  • Cover the site with a Band-Aid.
  • Follow this routine daily until the area where the hangnail was removed has healed.

If the area does not improve, if pain continues, or if redness and/or swelling ensues, see a dermatologist immediately.

Is Your Hair Falling Out?

Posted on: September 24, 2014

Telogen Effluvium Hair Loss

The average individual has about 100,000 hairs on their head. Hairs do not grow continuously, they grow in cycles. At any given moment, about 90% of the hairs are growing while the other 10% of the hair follicles are dormant and have no hair growing from them. An individual hair will grow for approximately 3 years (anagen phase) and then enter a resting state (telogen phase) for about 2 - 3 months. During this resting phase, that particular hair follicle has no hair growing from it.

Under certain conditions, more hairs enter the resting state (telogen phase) and an increased shedding of hair, or an "effluvium" is experienced (hence the name for this condition, telogen effluvium.) Patients  complain of a sudden increase in hair loss, finding hair on their pillow, on their shoulders, and in the drain when showering. The hair loss is usually diffuse, involving most of the scalp. Complete balding is not seen.  The exact cause of telogen effluvium is not known but one of the most common triggers for this condition is the hormonal changes seen at the end of pregnancy.

Some estimate that telogen effluvium occurs in up to 50% of women after giving birth with the majority of women noticing the hair loss between 8 - 16 weeks after delivery. Fortunatley, this type of hair loss is temporary for most, with hair loss lasting for 4 - 6 months before the hairs start to regrow, returning to normal in approximately 8 - 12 months.

Because telogen effluvium hair loss is a reactive process and usually resolves on its own, reassurance is the best treatment. There is no known cure for telogen effluvium but for those eager to try something, over-the-counter minoxidil may be of some benefit and is well tolerated by most patients.

There are many causes of telogen effluvium and hair loss in general. If hair loss persists or is associated with other symptoms, medical attention should be sought to rule out any underlying cause. Other etiologies of telogen effluvium, besides pregnancy, include:

  • As a result of major surgery
  • Severe trauma, physical or emotional
  • Acute illness including infections or other febrile illness
  • Chronic illness like malignancy, kidney or liver disease
  • Hypothyroidism
  • Medications (especially hormonal therapies)


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I've been a New York based dermatologist for over 25 years. I love music. I love triathlons. I love chemistry. (I love Petrolatum jelly.) I study skincare ingredients and product formulation. I listen to skincare "advice" from self-proclaimed ......Read More

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