Fully Exposed


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)


Posted on: September 02, 2014

Stretch marks (striae distensae) are pink, red or purple indented streaks that most commonly appear on the abdomen, breasts, upper arms, buttocks, and thighs. They are not a significant medical problem but can cause emotional distress in those affected. Although they eventually fade to a white or gray color, it is rare that they completely dissappear. 

Stretch marks are caused by a continuous stretching of the skin placing increased stress on the underlying connective tissue. Research published in the Journal of Investigative Dermatology shows that genetic predisposition increases the odds of getting stretch marks by 40%. Anyone can develop stretch marks, however, they are more prevalent in women than men. They are most commonly associated with:

  • Pregnancy: a combination of skin stretching and hormonal factors induce stretch marks in most pregnant women. 
  • Weight gain: individuals who experience substantial weight gain, adolescents, especially during growths spurts, and weight lifters who rapidly increase their musculature can all develop stretch marks.
  • Medication: chronic use of both oral and topical corticosteroids can induce stretch marks.
  • Diseases: stretch marks may be a result of certain conditions that involve abnormal corticosteroid levels (Cushing's Syndrome and other adrenal gland diseases) and certain genetic conditions that weaken elastic tissue (Marfan's Syndrome or Ehlers-Danlos Syndrome.)

Stretch marks are mostly a cosmetic concern as the majority of them fade over time.  Various creams, lotions and therapy options exist but none have proven to be more beneficial than any other, and, little scientific data exists proving 100% efficacy for any of them.

Prescription Vitamin A derivitives, like tretinoin cream, may improve the appearance of stretch marks that are relatively new (less than a few months old) but it is not recommended for pregnant or nursing women. Tretinoin cream can be irritating and has not been shown to be effective for older stretch marks.    

Several laser therapies are used to help rebuild the underlying collagen and elastin, but again, few are 100% effective and treatments are often very costly.

Microdermabrasion is used to gently remove the top layers of skin with the hopes of stimulating underlying collagen formation. Again, little scientific evidence exists showing efficacy of this treatment modality.

Creams that contain Vitamin E, fruit acids, olive oil, botanicals, and other extracts are often touted as stretch mark treatments. Although these products will not likely cause any harm, there is little science-based research showing that these products are effective

The best treatment (although still not perfect) for stretch marks is prevention. Maintain a constant healthy weight. During pregnancy, moisturize the skin twice a day to maintain adequate skin hydration, optimizing skin elasticity and strength, eat well, and exercise.



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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 petroleum jelly.) I study skincare ingredients and product formulation. I listen to skincare "advice" from self-proclaimed ......Read More

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