A Family Doctor’s Visit to See a Cosmetic Dermatologist for Sun Damaged Skin Part I: Poikiloderma of Civatte

A Family Doctor’s Visit to See a Cosmetic Dermatologist for Sun Damaged Skin Part I : Poikiloderma of Civatte

By Natan Schleider, M.D.

Dr. Natan Schleider’s Forehead. Note what appears different color tones which was diagnosed a poikiliderma.

I don’t wear skinny jeans. I wear flip flops whenever I can which apparently are out of style. And while starting to go bald–which I’ve decided to ‘own’ rather than pursue hair plugs or the ever popular toupee, the sun-damaged skin on my forehead has been bothering me (only when I look in the mirror).

Having spoken to my regular dermatologist, Dr. Roy Seidenberg (great, brilliant physician), he suggested a cosmetic dermatology consult for possible laser treatment.

Now I’ve had laser treatment before in my early 30s: laser hair removal on my back and chest. After 18 months of treatment every 6-8 weeks for a total package deal of about $3500, my back and chest were about 60% improved but I learned one valuable lesson: as I aged new hairs began to sprout on my back and chest (not to mention my ears, yikes!). So what I presumed–and is often advertised as a ‘permanent’ fix–not the case with me.

Friends have raved about various laser treatment for skin as the definitive cure while many patients of mine love Retin-A, a prescription cream or gel FDA approved for anti-aging (improving fine lines and sun spots). I tried Retin-A for a few weeks but realized I was soon forgetting to apply it at night (when I was negotiating with my 5 year old daughter Elie on the benefits of tooth brushing, a nightly debate).

Treatment for this would not be ‘one and done’ but would require a ‘series’ of treatments–the doctor would not commit on even a ballpark number but I would surmise 5-10 treatments. lasting ‘minutes’ after a numbing cream was applied. The stronger the laser each session, the better/faster the final results (meaning the more sun-damaged blood vessels are destroyed). If the laser is put on mild, minimal downtime, skin feels slightly sunburned, you can work same day. If laser is put on high power, skin is very red and inflamed and downtime expected to be 1 week. The cosmetic dermatologist suggested an in between setting.oping for a ‘one and done’ laser treatment to leave my forehead smooth and uniform in color, I saw a cosmetic dermatologist yesterday.

I tried to get a price idea on these laser treatments before the consult but found no great source?

Anywho, while I do have a few sun spots medically called solar lentigos, my primary problem in poikiliderma, a benign discoloration of blood vessels brought on by sun exposure underlying the skin leaving colors darker and lighter.

Treatments would occur about once a month and I ultimately got a price of $450 per treatment (which I think is low in the NYC area as it is a small region of skin being zapped as opposed to chest or neck where poikiloderma occurs more commonly.

The staff seemed surprised when I declined treatment at this time. Given this would be a long expensive process with best outcomes (based on my research) about 75% improvement, I paid my $200 consult fee and told them ‘I’d think about it’ which I will do.

The treatment would involve some type of laser which would take ‘a few

Any comments or experiences with cosmetic dermatologic treatments appreciated via Twitter.com or Facebook.com or Instagram.com.

Thanks for reading and I’ll keep you posted if I go back for laser treatment.

 

 

 

Cosmetic Medicine Part 1: What A Doctor Does for Prevention and Treatment of Sundamaged Skin

Cosmetic Medicine Part 1: What A Doctor Does for Prevention and Treatment of Sundamaged Skin

by Natan Schleider M.D.

July 23rd, 2018

Now that I am 42, those blissful days at the beach when I casually remembered to add SPF sunblock occasionally are catching up. Suddenly my skin in looking like it has some age spots, wrinkles, and my forehead has pigment changes.

I realize I’m no male model but when ‘liver spots’ appear I start worrying that shuffleboard all day and dentures are on the way so let’s nip this in the bud in the most cost effective way possible.

Natan Schleider MD sun-damaged skin on foreheard
Natan Schleider MD sun-damaged skin. Note two dots on back of my hand.

I’ve been using Retin A Micro Gel 0.06% for about a few months and see no results so I’m considering other options.

According to John Hopkins these are my treatment options:

  • Botulinum toxin type A. An injection of botulinum toxin (a complex type of protein) into specific muscles will immobilize those muscles, preventing them from forming wrinkles and furrows. The use of botulinum will also soften existing wrinkles.
  • Chemical peels. Chemical peels are often used to minimize sun-damaged skin, irregular pigment, and superficial scars. The top layer of skin is removed with a chemical application to the skin. By removing the top layer, the skin regenerates, often improving its appearance.
  • Soft tissue augmentation or filler injections. A soft tissue filler is injected beneath the skin to replace the body’s natural collagen that has been lost. There are multiple different kinds of fillers available. Filler is generally used to treat wrinkles, scars, and facial lines.
  • Dermabrasion. Dermabrasion may be used to minimize small scars, minor skin surface irregularities, surgical scars, and acne scars. As the name implies, dermabrasion involves removing the top layers of skin with an electrical machine that abrades the skin. As the skin heals from the procedure, the surface appears smoother and fresher.

    A gentler version of dermabrasion, called microdermabrasion, uses small particles passed through a vacuum tube to remove aging skin and stimulate new skin growth. This procedure works best on mild to moderate skin damage and may require several treatments.

  • Intense pulsed light (IPL) therapy. IPL therapy is different from laser therapy in that it delivers multiple wavelengths of light with each pulse (lasers deliver only one wavelength). IPL is a type of nonablative* therapy.
  • Laser skin resurfacing. Laser skin resurfacing uses high-energy light to burn away damaged skin. Laser resurfacing may be used to minimize wrinkles and fine scars. A newer treatment option is called nonablative* resurfacing, which also uses a laser as well as electrical energy without damaging the top layers of skin.

*Nonablative dermatological procedures do not remove the epidermal (top) layer of the skin. Ablative procedures remove the top layers of skin.

I’m leaning toward the laser because I am inpatient and want fast results but the price in New York City may be $1,000-$2,000 so I may need to go with something else?

I recommend my dermatologist who isa brilliant and has a great bedside manner: Dr.Roy Seidenberg [https://www.laserskinsurgery.com/Dermatologists/Roy-Seidenberg-MD

To be continued after consult…how exciting!

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Thx for reading!