Monthly Archives: June 2014

Derm Girl Gone Wild

For those of you that know me at all you know I can get pretty excited about some things. I’m a high energy person and that energy explodes before vacations, when my family is having fun and with anything dermatology. The past 5 days I have been at my favorite educational conference of all time, Maui-Derm. It is a conference for NP’s and PA’s in dermatology. A LOT of the big names in dermatology are there to speak and it is so much fun learning about new advances in dermatology and networking with peers. I was honored to listen to Dr. Zirwas, the world’s leading expert on hot tub allergy, Dr. Zone who has published over 100 original articles and over 40 book chapters related to immune disorders in the skin, Dr. Rosen who has a resume I can’t even fit in this blog post, Dr. Rich who is a founding member of the Council of Nail Disorders, Dr. Marghoob, the world’s leading authority on dermoscopy, and so on and so on and so on. Who I came in contact with this past week made me feel what I would imagine is the equivelent feeling a 13 year old girl feels when she meets Justin Beiber. So this week I would like to share with you some of the exciting news in dermatology and “pearls” that I heard about this past week.

1. New Drugs- You have all seen the commercials for Enbrel and the other injectable medications we use for psoriasis. Well there are a lot more in the pipeline. Medications for people with chronic urticaria (hives that won’t go away), topical prescription products for brittle nails, Dalvance, an antibiotic like Vancomycin but less toxic. I mean we are really getting some cool drugs in the derm world which is exciting for people that haven’t had any luck with what has been available.

2. Arkansas made a top 10 list- Okay so during the venereal disease talk they put up a list of the top 10 states with the most syphillis and Arkansas was on that list. Sigh

3. Coconut Oil- With the world becoming a greener place people often ask me about natural products. We reviewed a research article that tested coconut oil against mineral oil for dry skin relief. It found that coconut oil showed 68% improvement versus Mineral oil’s 38% improvement. I wish they would have tested it against my favorite, petroleum jelly, but they didn’t so moral of the story is, go ahead, use coconut oil for a moisturizer. Seems to work well.

4. Hidradenitis advances- Hidranenitis simplified is a chronic problem where you get “boils” commonly in the groin and armpits. It can be scarring, painful and REALLY difficult  to treat. Some people have surgery to get rid of a large portion of skin and it still comes back. We reviewed studies about new treatments including new antibiotic combinations, metformin, (a medication for diabetes) and biologics (medications for psoriasis, bowel diseases and bone diseases). Hopefully we are getting better answers for people that suffer from this horrible disease.

5. Women use 12 skin products with 168 ingredients per day. Enough said. Please let Johnson Dermatology trim down your products. Help us help you save your skin and pocket book.

6. Gonorrhea- There is a new gonorrhea that recently made it to America that is drug resistant. That means we don’t have a good treatment to rid it like we do with the traditional Gonorrhea. Oh, and it is believed to be passed by oral sex. Not cool.

7. Nail Melanoma fact- 25% of nail melanomas are amelonotic. That means they don’t have that black, brown color in them. Frightening! Please keep your skin cancer checks at least yearly so a dermatologist (the skin experts) can help catch skin cancers early.

8. Scary Treatments- The main cause of death from the autoimmune blistering disorders is side effects of oral steroids. One in 300 people who have a sentinel lymph node biopsy will have a stroke related to the procedure. Although oral steroids (example-prednisone) and procedures can be very helpful in mutliple diseases these things have side effects and all clinicians should be reminded of that often, to do no harm.

9. Patients don’t fill prescriptions- Historically speaking people have said studies show that 50% of people fill the prescrition they were given from their doctor. Hmmmm, I know ALL my lovely patients fill their prescriptions. My patient’s are perfect!

10. Melanomas are changing- Most people know the ABCDE of melanoma and how it helps to spot melanomas. But now, some of the top expert dermatologist are using a different acronym called “looking for the ugly DUC”. The D stands for different then all the other moles, U is for uneven. Uneven in any of the Asymmetry, Border or Color of the traditional ABCDE. Lastly the C stands for Change. Any mole that is changing warrants a biopsy. Just another reason you need a skin expert in your life.

That wasn’t even 1% of the exciting things I did this past week. So come see me at Johnson Dermatology and I can give you an ear full of the other 99%! You will see me get excited if nothing else!

Hey, did you know Johnson Dermatology is having a hashtag contest this summer? Use #Johnsondermatology this summer in any skin related post and you could win a prize. I’ll be watching on social media so be sure to follow us on facebook or my personal twitter @skinnyonskingal

Dance the week away (in sunprotective clothes),



Because I’m Happy

This week Honey (the best Physician’s Assistant ever) became my neighbor. For those of you that haven’t met Honey, she has been a PA at Johnson Dermatology for about 3 years and truely is a gem! She is my work sister. For most of her time at the clinic she has commuted from Tulsa, OK. I’m not sure if she moved here because she was tired of the drive, loves the Fort Smith community, got sick of people asking why she commuted or just really wanted to be my neighbor. I am sure of one thing though and that is that Honey and I would both move mountains to be able to work at Johnson Dermatology forever. Some people never find a job they are happy going to every day. Your work life really does affect your overall happiness. When I sit back and reflect about why I love my job so much the obvious things come to mind first. I love my patients, I love what I do, I love my coworkers, I love my hours, I love the location and I have great bosses. There are some things about being happy at work that are just up to the person though and so this week you may not learn a skin trick but you will learn something about Johnson Dermatology and why we love our jobs. Here are some of the Johnson Dermatology Midlevel tricks to a happy job inspired by my new neighbor Honey Hill.

1. We try to be healthy– Don’t get me wrong, we currently have a large bag of chocolate in our office. But generally speaking we both stay on each other about sticking to healthy food. We recently did a juice cleanse together. We ban ourselves from Starbucks sometimes when it gets to be too frequent a habit. I go to barre regularly and Honey runs with her fiance. The point is, our bodies feel good and are feuled to feel good at work. If you feel good and look good, you’re setting yourself up for a better work jive.

2. We find a reason to dance, every morning– Have you ever seen kid president? If not, go to you tube and watch all his videos. In every single one he dances at some point or recommends it in making the world a better place. Every morning Honey and I play music to dance to while we get ready for our first patient. We may only get 20 seconds of a song, we may get 2-3 songs in, but we don’t skip dance party time. If my baby woke up 50 times last night or Honey is sick of driving (not anymore) it clears that bad mambajamba and brings happiness and joy to start the day with a good attitude. I am usually the only one dancing in my chair and I nominated myself DJ but Honey does a lot of the lip syncing. Most of the time we don’t need a reason to dance but some days we choose something great about work and dedicate our dance party to that. So instead of thinking about how tired we are, we think about the patient we saved from Melanoma. Try it! I don’t have the science behind it but it works everytime, I mean 100% of the time… Dance people!

3. We don’t make excuses– Excuses are great, aren’t they? I mean they totally take a little of the blame off of you. Whether you’re placing the blame on circumstances or someone else, with an excuse problems are less your fault. Get rid of excuses. Honey and I were covering a duty while one of our co-workers was out. Honey had Wednesday and Friday to finish this task and I had Monday, Tuesday and Thursday. Well, when we got to work Wednesday morning we realized that the person who sets everything up for Honey to do this task wasn’t told about the change of plans, so it wasn’t ready to go. The easy thing to do would be to say that because it wasn’t set up and ready to go, Honey could just do the task later. But being that it was not set up and ready to go would just be an excuse, because really, that would just be a bump in the road that slows you down but you can still get it done. So Honey and I set it up together, helped each other finish the task, got it done twice as efficiently and boom, it was done. When someone asks you to do something at work, do you say “I won’t have time” or “I don’t know how”? Those are excuses. Make time and learn how. I think you will be proud of yourself, feel like a harder worker and therefore be happier in your job.

4. We admit we have weaknesses and make mistakes– Honey told me last week that she was sorry for biting my head off. I apologize daily for being inpatient. My blunt, straight forward attitude is my best friend and worst enemy. I apologize for it often. We know we aren’t the best to share an office with or to work for. We aren’t perfect employees. But we want to be the best we can be. We try to recognize our faults and improve on them. It’s like a step program. The first step is always admitting you have a problem. I got 99 problems but finding ‘em ain’t one.

5. We put others before ourselves– All day, every day. We try to never tell our bosses no, as a general rule. We try to keep our nurses happy. We try to do things the way the lab staff asks us to do them. Above all else we put our patients first. They are always right, their needs come first. If a patient is waiting to be seen and I need to potty, patient first, everytime. If I’m hungry but my first patient after lunch got here 30 minutes early, patient first, then lunch. Kid president says you should treat everyone like it’s their birthday. That is especially true with your co-workers and in our case our patients. If everyone around you is happy that vibe surrounds you and you’re happier by association.

I know you all join me in welcoming Honey to the River Valley as her new home. I am originally from Fayetteville but Fort Smith has been my home since 2007 and I wouldn’t leave it for the world. I have lived in San Francisco, CA, Orlando, FL and many places in between but this little community is special and one that Johnson Dermatology is honored to serve.

Hope to see you all at the clinic this week with any skin needs you may have!

Peace, Love and Skin care, Nina



Happy Father’s Day

Happy Father’s Day to all you Dads out there. Fathers are so hard to buy gifts for, men in general really. After the basic cologne, polo shirt and sports equipment you start to run out of ideas. Lets face it, those basics only get you through Valentines Day and an Anniversary then you still have to figure something out for Birthday, Fathers Day and Christmas. Men, as the saying goes, can’t live with ’em, can’t live without ’em. So in honor of Fathers Day here are some men skin gift ideas.

1. Laser hair removal- Does your man have weird hair patches on his back? Or just hate shaving? Buy him a laser hair removal package. Price is dependent on the size of the area being done and he will likely need 3-5 monthly treatments. Now this is a little painful and we all know God didn’t make man able to carry a child for a reason but our laser technician Tasha is an expert and she gets most men through it without a problem.

2. Laser tattoo removal- Did your Dad get a naked lady tattooed on his arm years ago? Does your husband have an ex’s name inked permanently onto his skin? This is the gift that keeps on giving…… to everyone! Get him an ATV laser package to have a tat removed. The ATV laser we use at Johnson Dermatology is new to our laser family and we are seeing amazing results.

3. Bro-tox- Think your man is too manly for Botox? Consider this. We women started the tight jean look and now men are wearing the straight-leg tighter fit. Pink is a stereo-typically girl color, we have worn it since the day we were born. Now it is totally in style, men rock pink all over the runway. It’s just a matter of time before it is socially accepted for men to use Botox too. Tell him he isn’t necessarily metrosexual. Tell him it’s to help him stay competitive in the workplace with all those young new college grads. Tell him he has to keep up with you. Tell him whatever you want, after his first injection he will be hooked.

4. Aftershave balm- Not that fru-fru smells like you just walked in Abercrombie and Fitch stuff. The kind that is good for your skin. I like the Avene After-shave balm because it has purifying ingredients made to prevent bacterial infections, is alcohol free and a rich moisturizer. It will calm razorburn and is good for sensitive skin.

5. A Buff- Okay, seriously I am officially not as cool as I once was, or just don’t watch enough Survivor. A buff is a seamless tube of fabric that you can wear a million ways. It comes in all kinds of decorated fabrics. This weekend alone I have worn mine as a headband, neck gaitor and face mask to protect me from the sun. A wide brim hat can sometimes be difficult for a man to wear, especially during sports events. Your Father can use a buff as a hat liner to protect his ears from the sun and still be stylish in his ball cap. I’m pretty much in love with it and mad that no one told me about it sooner. Go to and get one, you’re welcome.

Hope all the Dads out there had an awesome Fathers Day. Next time you have to buy a dude a gift consider a treat for his skin. It is the largest organ in his body, it’s worth taking care of!

Stay skintastic this week and always!

Hope to see you all at the clinic, Nina

P.S. Check out my Buff as a facemask!



Skin Foodie

So incase you haven’t heard there is a new organic juice place in Fort Smith called Carrot Dirt. I love juicing but it can be a lot of work and since I have had my child my juicer has been collecting dust. The convenience of being able to buy a bottle of juice that is as good as the juice I made in my own kitchen is ahhhhhmazing. So one might say I’ve been a little obsessed. This week I did a 3 day cleanse and had nothing but juice. I talked it up enough that I was able to get Dr. Sandy and Honey to join in on the cleanse with me and it was actually really fun! We weren’t hungry, tired, cranky or anything really unpleasant. Actually, we felt great! We didn’t even drink all the juices we were allowed in one day because we were so full. Don’t ask me how much weight I lost because that wasn’t my goal. As a matter of fact I didn’t even weigh myself before or after. When I don’t have a lot of sugar and carbs and all the evils of food I just feel better. I can’t put my finger on what it is exactly but I think what it boils down to is food is simply fuel for the body. Just like your luxury Lexus, you can put premium gas in your car and run smoothly or you can use regular unleaded. The car still goes but your Lexus engine probably skips a few beats without the good stuff. There are lots of reasons to eat healthy but is good skin one of them? I get this question a lot. The simple answer is yes, there are conditions of the skin associated with food but if you are just looking for overall skin health there are other things I think you should put at the top of your “steps to healthy skin” list. For example, in my opinion sun smart behaviors are more important for your skin health than eating blueberries everyday (these berries make magaizine “good food for the skin” lists all the time). Here are a few food tips I do recommend for the skin.

Vinegar- This is one we use in dermatology for a variety of things. One of the most common is mixed toe webb infection. It’s that athlete’s foot like rash between your toes. I usually recommend a 1:4 vinegar to water ratio to soak your feet in.

Red Dyes- These are a no-no for people with perioral dermatitis (an acne-like rash around the mouth and chin). Try to avoid things like cinammon gum, fruit punch and diet Dr. Pepper these red dye enriched foods have been known to trigger perioral dermatitis.

Yogurt- Ladies you know when your doc puts you on antibiotics and tells you to eat yogurt to ward off yeast infection? Well yeast can cause problems on the skin like the infamous “heat rash”. Get the good yogurt with cultures for the most benefit.

Potato Chips, Pizza and Ice Cream- Somehow these foods got a bad rep for causing acne. Although I think these foods should be limited in your diet for overall health the research hasn’t found them to have an effect on your acne. So while they increase your dress size they will not be increasing your pimple size.

Colloidal Silver- People have claimed silver supplements can help rosacea, psoriasis, viruses (warts, fever blisters) and bacterial infections. I don’t recommend this. As a matter of fact, if you aren’t careful you can actually turn your skin a blue hue with too much silver, a condition called Argyria. I’m sure there are easier ways to become part of the blue man group.

Caffeine and Alcohol- These are known triggers of flushing. Those of you prone to redness and flushing, you should avoid these as part of your treatment plan. An ounce of prevention is worth a pound of cure.

I wish the best of health to all of my followers. Check out Carrot Dirt if you are in the Fort Smith area, you won’t be dissapointed!

Hope to see you at the clinic this week and maybe we can chat about this ever so popular topic more.

Until next time, stay healthy, stay happy and ALWAYS stay skintastic, Nina


The Natural Look

By far the most frequently made comment from someone who is about to be injected with fillers or Botox is “I don’t want to look done”. Everyone wants to look natural. No one wants to be that person that everyone whispers about as they walk by “psst, look at Elsa, now that’s Frozen”. I agree! I certainly do not want any of my sweet, beautiful patients to look like they have been treated. But there is a lot more to the “natural look” than just botox and filler injections. The other things you do to beautify affect your entire look. So, this week I want to encourage you to embrace your natural beauty. Here are some tips to enhance you and not change you, keep you just like you are!

1. Pick an above average injector-Who you choose to inject your botox and fillers should not be whoever is having a sale. Your injector matters. Pick one who has a natural looking staff because likely she/he has injected them. If the person coming at you with a needle has lips that look unnatural and ducky then you can bet that’s what she is going for on you too, so take note.

2. Keep your eyebrows natural- If you were born with thick dark eyebrows don’t go to thin lines. If you were born with thin, hardly there eyebrows don’t go to thick tattooed permanent eyebrows. Tattooed eyebrows may be a look you are going for and if so rock it girl, I know some people that look great with permanent make-up! But sometimes I look at tattoed eyebrows and think “she has tattooed eyebrows”, it’s not a “not done” look, it is something people are likely going to be able to tell you have had done. Be careful how much you pluck and shape, try to enhance your natural shape not change the shape of your brows.

3. Careful with fake eyelashes- Now these have become ever so popular over the past few years and sometimes they look full and beautiful but I must say sometimes they will make you get the “done” look. If they are peeling away from where they were stuck, you’re “done”. If they are freakishly long, you’re “done”. If your eyelashes are so long that you can give butterfly kisses with a 2 foot standing distance from the other person, it’s unnatural. An alternative is Latisse. Latisse is a topical prescription that will give you those longer, fuller lashes you’re looking for in a natural occuring type of way.

4.Hair style affects the overall look- What is Dolly Parton known for? Her music sure, and maybe a couple other things, BUT that hair! I don’t know what the saying is about teasing it closer to heaven but bleached blonde hair that is that tall is not natural. It may be considered beautiful, but not natural.

5. Make-up matters- Do you guys remember Mimi off of the Drew Carey show? She had electric green and blue eyeshadows and hot pink lipstick. She was not going for the natural look. Now she wore it well but I am going to go ahead and say I feel comfortable recommending against that look if you want to become a more naturally beautiful you. Don’t cake on make-up. Get a skincare regimen that works so that you don’t need it. You CAN get there. You could be using a make-up that is actually irritating your skin and making your skin problem worse. I use Colorescience powder and also recommend Jane Iredale.

6. Be secure- This is key to keeping the natural you beautiful. Insecurities can lead us to change what is already beautiful. Sure, we can get botox injections, filler, color our hair, get a nose job, get fake lashes, tattoo on the brows we want, wear make-up so thick we are unrecognizable after a shower but all that together, it’s just not us anymore. We should enhance what we have to feel good without changing what we look like. That takes embracing our imperfections sometimes. The perfect example is filler and botox goals. Your goal should be ten years younger, not thirty. A 60-year old with skin that is as tight and wrinkle free as a 20 year old is unnatural. You don’t want to rid every single line because at 60 a few lines show maturity. Look natural, you’ve earned those lines and you’re still beautiful. If a 60 year old wants enough filler and botox to rid every line and get the tightness of a 20 year old, it can be done but it’s not natural, it’s just done. But a 60 year old that looks like a 50 year old naturally occurs all the time so we can do that and look very natural.

I hope you all feel beautiful when you come to see me and even more beautiful when you leave me! There are a lot of opinions in this world and these are just mine so I really appreciate all of you that follow, trust and listen to my blog. Above all else, beauty is in the eye of the beholder so when you look in the mirror remember that, be nice to yourself. Hope you have a great week!

Stay totally skintastic, Nina