Monthly Archives: October 2014

Who is your skin expert?

So, I like to think I’m cool. I’m probably about 1/4 as cool as I think I am but hey, I try to keep up. I like fashion, I like pop culture, I love social media. Like seriously, how did people stay hip in their 30’s without social media. I often search hashtags like #skincare #skin #dermatology along with the usual #kimandkanye , #ootd and #widn. Some of the skin care tweets pain me. Such as the ones that recommend smashing berries and mixing them with honey and toothpaste and rubbing it all over your face for acne. As my little girl would say “ewww, gwoss”. Or the ones that list the top five exfoliators, all including beads and scrubs that I consider harsh on the skin and would never recommend. There are also tweets from dermatologist but let’s get real. There aren’t as many cool derms out there tweeting as there are hip, young skin bloggers. Most of my favorite derms have a couple thousand followers (at most) where skin bloggers usually have 20 thousand followers or more. So I started to wonder why?

How do you pick your skin expert? I mean it’s pretty cut and dry when you need brain surgery, the neurosurgeon. When you need a root canal, the dentist. When you need the dreaded colonoscopy, the gastroenterologist. But it’s not that easy when you have acne. Do you go to an aestetician, a spa, a family doctor, a make-up counter at a drug store or a dermatologist? How do you chose who is going to be your skin expert? I mean obviously, I’m not neutral and I think the dermatologist is the expert. I mean don’t dermatologist spend the most time in school learning about skin? Doesn’t that make them the experts? Or do you look at experience? Does an aestitician with 40 years of experience have more experience with skin than a dermatologist that just got out of residency? Or is the proof in the pudding? Does a make-up artist for the stars who makes celebrities’ skin look flawless and now travels the world sharing her tips get expert points over say a dermatology nurse practitioner in Fort Smith, Arkansas who has only treated the locals? I’m not sure what the answer is for you, for Americans. Do advertisements play a role? Are you persuaded by where your friends go? Do you have a dermatologist?

I would like to think that most dermatologist have an evidence-based practice(like Johnson Dermatology does). We go off of science. What the research says works is what we believe in and recommend. Did you know Dr. Brad, Dr. Sandy, Honey and I review the literature together on a regular basis? Do you think your skin expert does that? I hope so. I think that’s what sets us apart from other skin faux experts. Although I must say our experience plays a role and the products we prefer does vary somewhat within our specialty. But there are some things that don’t vary and those are the things that you want to be sure you don’t stray from. Here are my dermatology tips that you should never break from, no matter who tells you otherwise…. well as long as you trust me.

1. Be sunsmart. As a whole, the dermatology world has lots of research which shows that UV damage increases your risk of skin cancer, wrinkles and dark spots. Sure there are benefits from minor amounts of UV rays that some people will try to capitalize on but there are TONS of benefits from being sun smart. So wear your sun protective clothing, wear your SPF of 30 or higher and know you’re helping your skin stay healthy.

2. Don’t use harsh products. We all agree that scrubs, beads, exfoliators and harsh products irritate and inflame the pores of the skin. Use gentle products for your skin. No matter what product you use, avoid the harsh stuff.

3. Retinol is your anti-aging hero. Sure other fads will hit the market. Right now it seems like all the “green” and natural stuff is really popular but for now the oldest ingredient that hasn’t changed in the research and literature is Retinol. Retinol passively exfoliates so for all you exfoliators out there who say you can’t live without scrubbing, try a retinol. It’s the workhorse, it shrinks your pores, decreases oil production, decreases dark spots, helps fine lines and lightens and brightens. You can see this product working on the skin at a microscopic level. How cool is that?!?!?

4. Watch your skin- Just like women should do self breast exams monthly everyone should do skin checks on themselves. Watch your moles, look for new, changing, growing, and non-healing lesions. Of course I would love if you had a dermatologist look your skin over head to toe at least once a year.

5. Be happy and confident in your own skin. Throw away your magnifying mirrors. Be thankful for the skin you have been given because you are the only one in the world that has that skin. You are beautiful. Anyone who tells you to change your skin is wrong. Choose a skin expert that can bring out your natural beauty.

I hope I don’t offend anyone with this post. I realize there are people other than dermatologist who are great with skin. But I also realize there are people out there who are making money off of skin advice and selling skin products who are not experts, who don’t have the best advice and I don’t know how the consumers filter out the experts from the faux experts. Be aware, be alert, be smart. Always know that I am honored when you chose me as your skin expert and promise to always do my best to be the best for you and your skin.

Happy Weekend, stay skintastic, Nina


What’s Your Health Fear?

I traveled to Washington, D.C. this weekend for a work meeting. All my friends and family warned me to bring lots of hand sanitizer, to consider wearing a mask, to avoid touching any bodily fluids, to avoid flying through Dallas and to be on high alert for Ebola. When you travel, you spend more time than normal on your social media. You never check your feeds during important business meetings underneath the table (shout out to my bosses)but during breaks, flights, lonely nights in hotel rooms, etc you definetely have time to check IG, Twitter, Facebook and roam the internet. I saw a few pictures of kids at pumpkin patches and the usual but most of my feed was clogged all weekend with #Ebola. Twitter has #ebola trending at 1.3 million tweets. Who doesn’t know the nurse named Nina that has Ebola? (hint:it isn’t me) One of NPR’s stories got me thinking. It was titled “Why won’t the Fear Of Airborne Ebola Go Away?”. It talked about how many experts and officials have said Ebola isn’t airborne and the chance of the virus mutating to be able to travel airborne is less than 1% and no matter how many times the experts express this people are still suggesting stopping air travel and extreme quarantines and worse. This particular article seemed to think it was because of the media. It’s quite the debate on some of my friends social media feeds, what we should be doing about Ebola in the US.

While contemplating in my mind why people have such a fear for Ebola I wondered to myself “Why don’t people fear Melanoma?”. So often I have patients tell me they are going to keep getting in the tanning bed even after I express all the harm UV rays can do to the skin. I have had people go as far to say, and I quote , “guess I will just die of cancer because I’m not going to stop tanning!”. It seems so absurd to think my community has multiple tanning beds available yet are so fearful of Ebola. Why? How do we choose what we fear for our health? Do we go by what the experts tell us? No that can’t be it because I think dermatologist are the experts of skin and people often go against that advise. The CDC officials are the experts on infectious disease yet people don’t seem convinced that Ebola is not airborne no matter how many times they state that fact. Is it research and science? Nope. According to the CDC one person has died in America due to Ebola. CDC says, in the past decade, the United States had 5 imported cases of Viral Hemorrhagic Fever (VHF) diseases similar to Ebola (1 Marburg, 4 Lassa).None resulted in any transmission in the United States. According to the American Cancer Society five-year survival rates for distant stage melanomas (melanoma that has spread to lymph/distant organs) is 16%. According to the American Academy of dermatology it is estimated that by 2015, 1 in 50 Americans will develop melanoma in their lifetime. So according to the stats we should be fearing melanoma before Ebola, right? So why is Ebola so feared and melanoma taken so lightly in our society? Is it the spin media puts on Ebola and rarely mentions melanoma? Is it majority rules? Meaning most people fear an outbreak and don’t fear a tan that increases the risk of melanoma? Is it how we were raised? Patients often tell me “when I was young we didn’t know to wear sunscreen” did this non-concern as children wear off on us? Were we raised to believe infectious diseases are some of the worst by Mom telling us to cover our mouth when we cough, wash our hands, put our jacket on before we catch a cold? I don’t know why but currently in our society there are 1.3 million people talking about Ebola on Twitter and not even a fraction of that talking about melanoma.

I think people that fear an Ebola outbreak in the United States could be compared to people that fear the end of the world. You know that person that thinks the world is coming to an end and builds their house on the highest point in town and stores enough water and food for a year, puts bars on the windows and is ready for the end of world or a zombie apocalypse. We “normal” people think it’s overkill. We might even call that person a little weird. But if the zombie apocalypse came tomorrow or the world came to its end, then that would be your smartest neighbor. Everyone would wish they had prepared for the end of the world. The person that refuses to fly, wears a mask everywhere and doesn’t touch the buggie at wal-mart sure would look smart if there was an Ebola outbreak tomorrow. Luckily for us, statistically speaking, the Ebola outbreak won’t be here in the U.S. tomorrow and neither will the world come to an end.

Melanoma is already here, and it has killed a lot more than one American. So this post isn’t to convince you to chill out about Ebola. It isn’t to scare your pants off about Melanoma (well it kinda is). But I do hope it makes you think about your health. I hope it makes you think about the source of information you trust and make decisions about your health. Do you follow the guidance of an expert in healthcare or a commercial during your favorite TV show? My hope and prayer for you is that you let there be enough anxiety in you about heart disease that you work out and eat healthy, that you have enough fear of lung disease to not smoke cigarettes and of course that you be frightened enough of melanoma to be sun smart.

I think this guy behind the White House this weekend might fear an Ebola outbreak, just a guess. At least his skin is protected from the sun while he protest. I don't think he works for the CDC though, do you?
I think this guy behind the White House this weekend might fear an Ebola outbreak, just a guess. At least his skin is protected from the sun while he protests. I don’t think he works for the CDC though, do you?
Well at least he isn't tan......
Well at least he isn’t tan……

Until next week, stay healthy and always skintastic, Nina

P.S. If you have any ideas on how I could make #melanoma hit more than 1.3 million tweets and bring awareness to America just let me know!

Eczema got you down?

Atopic Dermatitis, otherwise known as eczema, is one of those things you don’t want to have. I mean sure, you could get something worse but this is the gift that keeps on giving if you have the chronic type. For those of you that don’t know it’s a dry, cracked, scaly, itchy rash. Sometimes it can be severe to the point where it causes swelling, pain and even psychological problems. It’s often more like high blood pressure than a toothache. With a toothache you go to the dentist, get a filling, maybe some antibiotics and “POOF” problem solved. A few years down the road you probably can’t even remember which tooth it was or that you even had a toothache. With high blood pressure as long as you take your blood pressure medicine your blood pressure stays under control but if you stop your blood pressure medicine then your blood pressure goes back up. We don’t have a cure for high blood pressure where you get a pill and then problem solved. Same story with chronic atopic dermatitis. As long as you do A, B and C it should stay under control but if you stop then boom, it’s back. The problem is what we ask you to do for eczema is so much more work than taking a pill once a day. Here are the first three things I ask my eczema patients to do that usually keep it under control.

1. Get Greasy- As often as possible lube your body up. My first choices are plain petroleum jelly or crisco. If that’s too greasy for you then my second choice is something plain and thick that comes in a jar. If it comes in a pump or something like that it usually isn’t thick enough. Put it on as often as you can and especially within 3 minutes of getting out of the shower to lock in all that moisture.

2. Avoid irritants- Think about fragrances, colors and additives like wool. If you rub wool on your skin it’s going to cause an irritated rashy spot. Things much gentler will irritate the skin of someone with eczema. Baby soap is a no-no because they put a fragrance in it to smell like baby. Seriously, the plainest plain is what you want, no oatmeal added blah, blah, blah. I like plain Dove soap. Oh, and speaking of Dove, have you seen their legacy video? If you have a daughter it’s a must see, you can thank me later.

3. Prescription lotions, creams and ointments- The most common being topical steroids which can’t be used long term because they can cause side effects such as acne, thinning of the skin, stretch marks and more. So we usually reserve them for flares. There are non-steroidal options too like Calcipotriene, Elidel, Vectical and Protopic, to name a few.

Those are the basics but as an additional tip I usually ask my eczema patients to do occasional bleach baths. It’s a 1/4 cup of bleach in a full bath tub and you soak in it for 20 minutes. It kills all the stuff that lives on our skin and gets in that cracked skin keeping it from healing and causing infection.

After you’ve done all of the above and still aren’t getting to where you want to be, we start trying all different kinds of things that may or may not help. We may ask you to do wet-to-dry dressings. Some people get patch tested to find out if something they are coming into contact with is causing/worsening their rash. Some people get UV light treatment to try to decrease the skin’s immune system. Sometimes we put you on short courses of oral medicines. There are lots of tricks of the trade. If you are suffering with chronic atopic dermatitis and gave up a long time ago and just kind of live with it, STOP! Come see me, spend some time with me and let me try my best to help you.

This post was born after seeing our ad in the newspaper today, did you see it?

Happy Sunday Fun Day to all, Nina


Nina’s Top Picks

If you follow Johnson Dermatology on Facebook then you may have noticed we have been introducing team members and their favorite products. If you don’t follow us then you should so you can hear about our amazing team members and all the personal favs. I thought this would be a good time to re-introduce myself and give you guys my regimen and favorite products.

If you have yet to meet me at the clinic, then you don’t know that I am the happiest person ever right now. It hasn’t always been that way. I have been in bad places before, not as nice, not as happy. Where I am right now though, is the best I’ve ever been, on top of my game. If you ever cross my path, now is the time. This girl is on fire!

When I was a little girl and my mom asked me what I wanted to be when I grew up I replied “a plastic surgeon so I can make you beautiful”. Kids are mean. My mom was already beautiful. The point is, I have always known that I wanted to be in health care, helping people. In kindergarten, my teacher sent a book home with me before we had learned how to read and told me to just practice reading with my mom and I could show her what I learned the next day. I took the book home and told my Mom I had to learn the entire thing. I cried while working on it that night worrying I wouldn’t be able to read the entire book the next day (even though my teacher didn’t expect that of me). I forced my Mom to spend the entire evening teaching me to read that book and the next day I read it to my teacher. I’ve always wanted to be the best academically. So with a combination of a passion for helping people and a serious competitive dedication to academics (I graduated grad school top of my class with a 4.0, toot, toot) it only seems fitting that I am a dermatology nurse practitioner now and the happiest I could be in my career.

It’s not just my career either. It’s the total package. I have amazing friends, a husband that I don’t deserve, an above average daughter, wonderful family and a lovely home. I hope my cheer doesn’t annoy you, like that person that everything is always perfect in their life. I’ve made a D in a class before, I’ve been confused about my career path, I’ve dated some real duds, I’ve been a mean girl before and probably worse. It just so happens that through all that I got here and I’m feeling blessed at this moment. Some of my favorite things are traveling and eating good food. My Dad is an amazing chef from Malta (an island in the mediterranean sea) who gave me my love for fine cuisine. I love traveling so much that I was actually a traveling nurse before I was a nurse practitioner. I have worked in hospitals across America from San Francisco, CA all the way to Orlando, FL. But the most exciting thing about me (for the purpose of this skin blog) is my skin care regimen, right?!?! People always ask me “What do you use?” so here it is!

Body Moisturizer- I use plain vaseline on my legs. I use Cerave SA in a jar (white jar with blue lid) for everywhere else. I have a common condition called keratosis pilaris on the back of my arms. It’s a bunch of tiny red bumps. The Cerave SA improves that more than anything else for me. I just can’t use it on my legs because it burns after shaving, plus my legs get drier than the rest of my body and need stronger moisturizer.

Face Skincare Products- I use sunscreen every AM. If I’m dry then I use Elta MD and if I’m feeling greasy then I use the BOB. I use SkinMedica Retinol every night.

In the Shower- I wash my body with plain dove soap. I wash my face with Cetaphil Dermacontrol foam wash. It’s super light. I also wash my face with my Clarisonic. Get real, it’s like a face massage, so relaxing!

On the go- When I’m traveling I wash my face with Cetaphil gentle skin cleansing cloths. They come in a blue package and are by far the most gentle cloths that I have ever tried.

Injectables- I use Botox. I’ve had Dysport and Xeomin but Botox is my personal favorite. I also have Voluma. I’m ashamed to say that I am a baby when it comes to needles. I can stick them in people all day long but I just can’t stand being the one getting poked. So Voluma is an obvious choice for me because it lasts two years unlike a lot of the injectable filler’s  that last one year or less. In my mind that’s being injected less often which is a total plus for a baby like me! Plus it is so smooth. I use 44 units of Botox and I have one syringe of Voluma in each cheek(total 2 syringes)…. and I still look naturally beautiful, BOOM!

Make-up- I use ColorScience powder and my favorite eye shadow is a Jane Iredale trio called Golden Girl.

Laser- I love the results of laser hair reduction. I also think the PDL is so nice to take the redness out of acne in a quickie. Pre-prom or pre-wedding, that PDL is a life saver.

Fav Peel- I have had the vitalize peel and it was shocking how much one peel changed my skin. It calmed down my acne and faded a lot of my brown spots, highly recommend!

Well enough about me! If you want to learn more about the products I use or what I think would fit your needs come see me at the clinic. I honestly enjoy every single patient I get the honor of meeting and being a part of their skin. You guys are a part of my happiness. So thank you for trusting me and making me a happy person! Hope to see you all at the clinic soon!

Cheers, Nina