Monthly Archives: August 2014

Thank You Lemon

Hi, my name is Nina and I am a blog stalker. I just love following blogs and getting to know people I have never met. It keeps me pretty cool too(so I tell myself). You learn about what all the hip kids are doing. It’s how I keep my little girl so fashionable. Why my step sons think I’m not old and dorky. Why I have been “no-pooing” (not using shampoo).

One of my favorite bloggers is Allison from Her IG feed is awesome too @allisonpants. She is a super cool Mom with an adorable daughter named Lemon. About a month ago I was perusing my IG feed and saw that her daughter, Lemon, who is just a few months older than mine was suffering from Molluscum Contagiosum. Molluscum are bumps on the skin caused by a virus. When I see this in the clinic my initial reaction is “oh no big deal, just molluscum”. They always go away eventually, they are very common and not necessarily harmful to your health. For these reasons, I traditionally have put them directly in the “no big deal” category. And then Lemon got molluscum and changed my view forever.

I realized how it was the worst thing going on in Allison and Lemons life at that time.  That it was stressful, hard to treat, and that it tried to steal away some of Lemons joy. Molluscum Contagiosum were not falling in the “no big deal category” for this family I loved (via internet).  If it bothered someone as down to earth, laid back and flat awesome as Allison and Lemon then it really does affect people worse than I ever dreamed. I was reminded that when I walk out of the room of a patient who has life threatening melanoma and into a room with molluscum, I can’t compare them. One will surely go away without harm and one could kill but they are both quite possibly the worst thing in that person’s life at that given time. So I’m sorry to all my patients that I haven’t empathized with about their skin diseases. I didn’t mean to make you feel like your bumps weren’t a horrible thing to have. From now on, I promise to show more sympathy to all my patients’ skin problems, life threatening or not. Thank you Lemon for reminding me where my heart was when I started dermatology and where I need to keep it. I honestly care about my patients’ skin and their health. As a thank you to Lemon here are some facts and tips on Molluscum Contagiosum.

What is Molluscum Contagiosum?

Little flesh-colored bumps that grow on the top layer of skin caused by a virus. They look like tiny belly buttons. They are very common in kids ages 1-10 years old and will all be gone in about 2 years without any treatment.


How to get rid of the little buggers quicker?

-Be sun smart- Sunexposure and tan decreases the skin’s immune system which in turn makes it more difficult for the immune system to recognize the virus and get rid of the bumps.

-Don’t pick, scratch or shave over the bumps. This can spread the virus/bumps to other locations on the skin.

-Don’t quarentine your child. We all come into contact with the virus all the time through touch or sharing hand towels or whatever. Some people come in contact with the virus and don’t get the bumps while some people do get the bumps. Basically no worries, chances are kids are gonna either get it or not get it no matter what.

-You can see your dermatologist about once per month for treatment to try to get your skin to recognize the virus quicker. At Johnson Dermatology we use liquid nitrogen, cantharadin (blister beetle juice that doesn’t hurt), prescription creams and extraction regularly to treat the bumps. On average kids need 3-6 monthly visits before the molluscum are gone for good.

-Treat them everyday at home to make them go away quicker. I usually tell people the easiest (and likely cheapest) thing is to get a bottle of clear nail polish and paint the bumps daily. Other at home methods include salycylic acid, apple cider vinegar, vicks vapor rub, duct tape and more. Just pick whichever one you will actually do daily.

I’m sorry that sweet little children have to deal with Molluscum Contagiosum. I am now more sympathetic to all my kiddos and parents who suffer with these bumpy skin nuicances.  Just remember, your child is still beautiful, loved and healthy. Hope to see you all in clinic this week!

Remember “Little girls with dreams become women with vision” -unknown

Peace, Love and Sunscreen,  Nina


Skin Debates

Imagine that you are a dermatology nurse practitioner. Imagine you have spent the past 12 years of your career working at keeping people healthy. You are married to a police officer whose health knowledge goes as far as knowing the difference between tylenol and aspirin, if that. You have a beautiful little baby girl. One day you are about to take the family to the park and of course, you are applying sunscreen on your daughter. Your husband notices that you are using a spray sunscreen on your daughter and angrily states “Haven’t you heard you can’t use that on kids, guess you’re just going to give our daughter asthma?”. Really? Wouldn’t you think you would be the skin expert? Well obviously this is me. And this was the moment when I realized that if my own husband believes what he heard on television over his skin expert wife then obviously the whole world is thinking the same thing.

Side effects. Every medication has them. Side effects are risks we take when we use a medication. have recently read a lot of articles becoming popular in social media about the dangers of spray sunscreen, too little sunexposure being detrimental to your health, the dangers of benzoyl peroxide and the lists goes on. So how do you decide who has the best advice? Do you still take a tylenol even though it could cause damage to your kidney? Do you eat gluten even though it has been linked to joint pain and bowel diseases? How do you know if the benefit of something is greater than the risk? How to you know which risks are more likely to occur?  I don’t know what the right answer is but here are some of the things that I consider to help me decide what risks to take in the world of skin health care.

1. How likely is the risk to occur? For example, the spray sunscreen. We don’t know what happens when you inhale spray sunscreen so until the FDA has that figured out they just said don’t use/inhale it. In my opinion if I spray it on my legs or my daughters back we probably won’t inhale it. Therefore making the inhalation risk unlikely to occur.

2. How serious is the risk? When a child stands behind a running car do adults yell out “get that kid she is going to inhale exhaust and get asthma!”? No, we yell “get that kid before she gets run over by a car backing up!”. I use that analogy with sunscreen. It’s more important to me that my little girl doesn’t age her skin prematurely and get skin cancer (get hit by the car) than if she inhales a little sunscreen (smells exhaust). But that’s just me.

3. Does the benefit outweigh the risk? My child is a wild woman. To hold her down and rub sunscreen all over her is a serious task. It’s like mud wrestling with sunscreen instead of mud. We are both worn out and sunscreen is EVERYWHERE by the time we are done. So for her, I choose a combination of spray sunscreen to her extremities and back where she is less likely to inhale it and then powder sunscreen everywhere else. I take the “inhalation of spray sunscreen risk” because the benefit of ease of application is more important to me.

4. Majority rules. So one Swedish study comes out talking about women who sunbathe having a lower mortality rate than woman who avoid sunbathing and all of the sudden everyone wants to get a tan? No. It’s one article, with lots of factors to be examined closer. There are hundreds, likely thousands of research papers done showing that sun exposure is linked to premature aging and skin cancer. Obviously, I gotta go with the majority.

5. I like the motto “everything is okay in moderation”. Even dermatologist prescribe a little UV light sometimes. We use UV light treatments to help people that suffer from psoriasis, occult pruritus, vitiligo and more. Sometimes you just have to realize some things are good for you and bad for you, simultaneously.

If you ever want to talk more about sun protection, side effects of medication or anything else skin you know you can just come by the clinic and see me! I just love giving my opinion! Thank you for trusting me and the Johnson Dermatology team with your skin.

In the words of Rowan Nath, “Don’t just dance, move the world!”

Hugs, Nina

A Letter to a Melanoma Patient

Dear Melanoma Patient (past, present and future),

I would like to start this letter by saying I’m sorry. I’m sorry this letter is to you. I’m sorry that even though you wore your sun protective clothes, avoided the hottest parts of day, sought shade and wore sunscreen, you still got Melanoma. I’m sorry nobody told you to get your skin checked at least once a year. I’m sorry you didn’t know UV damage puts you at risk for Melanoma. No matter what the circumstances, I’m sorry Melanoma picked you. I’m sorry this letter is to you.

As the skin expert you trust to take care of your skin, I want you to know a few things.

Your opinion matters. Sure I went to school for over half my life time and I know the science behind your Melanoma. I know what the governing bodies say about treating your Melanoma. I know the statistics on Melanoma. But I also know you are a person, a unique person. What treatments your body undergoes I want us to choose together. I value your opinion because, above all else, you know what your preferred options are. I will give you those options and my opinion but lets make your treatment plan together.

You are at risk. Once you’ve had a Melanoma you’re at risk for another Melanoma. You can’t change your skin type. You can’t change your genetics. You can’t change your past habits. You CAN change your future habits. Be sun smart. Seek shade. Wear your sun protective clothing. Wear your sunscreen liberally and reapply often. UV damage is the only risk factor for skin cancer that you have control over. Take control of caring for your skin. Get your skin checked. Be friends with a dermatologist and visit them as often as they ask and whenever you have new or changing moles in between visits. Rely on your dermatologist.

Your testimony is important. I have spent a lot of time studying skin and feel that I am an expert in caring for skin. The problem is that sometimes I get as little as 15 minutes of a year with my patients. I try to educate them on the importance of taking care of the largest organ in their body (skin) but you have an incredible power. You have a testimony to which people can relate. People believe you. People will learn from you. People will change because of you. Please help me save skin. Use your testimony to change people’s lives, to save their skin. What you have learned from your Melanoma, how you feel, what it’s like, how you’re scared, how you fight, what scars you have endured. Share them with the world so everyone can know the truth about Melanoma.

I am here for you. I’m proud of you for being a survivor. Let me help you anyway I can. I know you are scared, nervous, confused and that I can’t understand how you feel but please let me know what I can do for you. Let me check your skin all over. Come see me when I ask you to get your skin checks and anytime that you need me in between checks. I have dedicated my career to caring for skin so please don’t stay away too long. I am honored to continue to care for your skin and I vow to always do my best to keep you and your skin healthy. Take care, you are beautiful!

With encouraging words,

Your Dermatologist, Nurse Practitioner and/or Physicians Assistant

Athletes with Heart Also Have Skin

Fall is just around the corner and with all this beautiful cool weather we are having I am even more eager for fall to arrive. We are about to be sending the children back to school. Fall and school bring lots of fun things including sports. Athletics are such a big part of my family and so many others. I mean we do live in the South where most small towns close everything on Friday nights to head to the local football stadium. EEEEKKKK it’s exciting just thinking about the fun that’s about to be had by all! Along with sports comes celebratory slapping of booties, wrestling with heads in armpits, showering with feet sharing space, contact with each other, sweat, dirt and the dreaded injuries. The point is there’s a lot of potential when participating in sports to cause harm to your skin. So if you participate in sports, or have a loved one participating in sports this post is for you. Here are tips for an athlete’s skin.

1. After you exercise wash with benzoyl peroxide soap or antidandruff shampoo to kill that funky stuff living on your sweaty body. An occasional dilute bleach bath can be helpful too. Simply put 1/4 cup of bleach in a full bath tub and soak for 20 minutes.

2. Wash your hands and clean under your nails as soon as you are finished exercising. Don’t share personal equipment such as towels and washcloths.

3. Clean your equipment. Do you know how much funk accumulates in that chin strap. I don’t, I don’t want to know either, clean that puppy.

4. Limit antibiotics. If you have ever turned on the tv then you have heard of antibiotic resistance. Superbugs. If you need acne treatment feel free to ask your dermatologist about alternatives (we are full of them).

5. Stay moisturized. If you have dry, cracked skin its like little reservoirs for bacteria and infection to start. Your skin is a protective organ, give it the tools it needs to do its job. I recommend plain, thick cream that comes in a jar applied at least when fresh out of the shower.

6. If you get an injury to the skin, cut, scrape, etc. then keep it covered with a layer of vaseline. Vaseline provides a barrier from infectious agents. It also helps with the healing process resulting in lessening of discoloration and scarring.

7. Be Sun Smart- Shade, sun protective clothes, sunglasses and sunscreen when applicable can protect you from harmful UV rays you will be exposed to during outdoor activities.

Have fun out there all you athletes. I am starting my running game back in hopes of participating in the Fort Smith Marathon. Have you heard? It’s going to be February 2015 and a total blast. Athletics don’t stop after school. It may be time for you to find your inner athlete again. Whether you have always been an athlete, love an athlete or are going to become an athlete I hope these tips help keep your skin healthy!

Remember, everyday is a second chance, hope to see you in clinic, Nina

P.S. Shout out to Dr. Sandy who inspired and practically wrote this list. She is an amazing female athlete!