Written By: Jamee Bonner

In an effort to protect its marine environment, Hawaii becomes the first state in the nation to ban synthetic sunscreen that is harmful to the coral reefs. The law specifically prohibits the sale and distribution of sunscreen containing oxybenzone and octinoxate, which will take effect in 2021.

“At first this may seem like a shocking decision that leaves tourists choosing between sunburns, skin cancer, or injuring our coral reefs, but it is crucial to realize only sunscreens containing two specific ingredients are included under the ban,” explained dermatology physician assistant Lindsey Smith. “There are still plenty of sun protective options to consider when visiting Hawaii including many sunscreens.”

The two additives included in the ban — oxybenzone and octinoxate – are said to cause, “mortality in developing coral; increase coral bleaching that indicates extreme stress, even at temperatures below 87.8 degrees Fahrenheit; and cause genetic damage to coral and other marine organisms.” A study published in the journal Archives of Environmental Contamination and Toxicology from 2015, found that 14,000 tons of sunscreen end up in and around coral reefs each year in Hawaii and in the Caribbean.

Sunscreens containing oxybenzone and octinoxate are known as synthetic sunscreens and soak into the top layers of our skin. Synthetic sunscreens protect us by absorbing UV rays, and then converting them into infrared rays. While they make up a large portion of sunscreens on the market due to their more cost effective price point they are not the only options available. Sunscreens containing titanium dioxide and zinc oxide are known as mineral sunscreen and are not affected by Hawaii’s recent legislation. It works by forming a protective layer on the skin and physically reflecting UV rays.

“All sunscreens, including chemical sunscreens, have safe ingredients that have not been scientifically proven to be toxic or hazardous to humans. The effect of chemical sunscreens on the coral reef does warrant more research and exploring other options when traveling. Mineral sunscreens are the types of sunscreen I recommend anyway, so it does not make a really significant change in my opinion, “ said Smith.

Which one should I be using?

Most dermatologist would agree that the best sunscreen is the one that you will use. Both types of sunscreens are effective and it all comes down to your circumstance and situation. What matters most in ensuring broad-spectrum protection from UVA and UVB rays, and diligently using whatever type you choose.

The American Academy of Dermatology Association has expressed concern that the restrictions could lead to an increase in skin cancer, particularly melanoma, which the organization says is already 30% higher in Hawaii than the national average. Nevertheless, doctors see this as an opportunity to increase their efforts in educating the public on the importance of sun protection.

“When visiting Hawaii consider investing in a mineral sunscreen or if all else fails use additional sun safety practices such as seeking shade, wearing protective clothing, and limiting time in the sun between 10am and 4pm,” said Smith.

As far as sunscreen usage in Utah no changes need to be made. Continue to wear SPF 30 sunscreen of any brand and type, reapply every 1-2 hours, and remain aware of how much time you are spending in the sun.

Written by Jamee Bonner

I am going through some major hair loss right now and each time I shower and brush my hair I feel like this lady below, seriously though!

My baby is now almost four months old and I am currently going through a type of hair loss called Telogen Effluvium. I was hopeful I would not get it this time around because the delivery and first three months were much less traumatic, but it is here and I hope it is at the peak and will start to slow down.

There are many types of hair loss, but I will be talking about this one since it is pretty common and I am currently experiencing it:) Did you know that is can be normal to lose up to 100 hairs a day due to the normal hair cycle? I don’t know about you, but 100 hairs seemed like a ton to me. What is a normal hair cycle?  The hair growth cycle can be divided into three cycles: 1. Anagen – actively growing hair 2. Catagen – Transition phase lasting 2-3 weeks where growth stops and follicle shrinks and 3. Telogen – Resting phase for 1-4 months (up to 10% of hairs in a normal scalp).

Now think about this, if there is a shock to your system, such as child birth, your hair cycle can reverse the ratio and your Anagen (growing) hairs can be triggered into Telogen (resting) phase.

Telogen Effluvium is a non-scarring type of hair loss where over-shedding occurs 2 to 6 months after an inciting event that stops active hair growth.

It is commonly caused by the following stressors:

1. Fever, weight loss, pregnancy/childbirth
2. Illness, psychological stress (Accident, death, divorce, etc..)
3. Surgical operations, medications and others

You will not go bald with Telogen effluvium, even though you will feel like it! It is self-correcting and rarely influenced by any treatment that can be given. The biggest thing in treatment of this condition is fixing the inciting event.

Now I want to mention one thing about hair vitamins that seem to be all the rage right now. If you have some sort of social media account I am sure you have seen celebrities and bloggers push Sugar Bear Hair vitamins. These blue gummy candies look cute but they are not going to help your hair grow! They contain vitamin A and C and a couple different B vitamins and Biotin. Biotin is not the holy grail when it comes to hair loss and there are actually very weak studies to suggest that Biotin improves hair, unless you have a Biotin deficiency which is really rare. I am not saying it won’t help, the power of placebo is real, and it won’t hurt so you can give it a try. However, a deficiency in Iron, Ferritin, vitamin B12, folic acid can slow hair growth. In short, my opinion is eating a healthy diet high in protein, fruits and vegetables is probably better for your hair than blue gummy bears:)

I think that winter finally decided to show up just in time for the Holidays. And with winter comes lots of dry, cracked skin that can lead to rashes.

I have a lot of patients at my Park City clinic that are from the East Coast and they always tell me similar stories, ever since living here their skin is very different. It is very dry and gets irritated easily or they have never had eczema in their life until moving here.

We do live in the 2^nd driest state in the country and our skin takes a beating, especially in the winter. Consequently, we have to be extra vigilant in taking care of it.

Xerosis is the medical term that means dry skin and it usually has a very dry, rough and scaly texture to it. It can develop little tears that can lead to some serious rashes and infections.

You may not have “eczema”, but we all deal with dry skin at some point or another, especially here. I don’t have particularly dry sensitive skin, but my hands sure do get hammered in the winter because I wash them 100 times a day to try and keep the winter bugs away from my baby.

Regardless of how mild or severe your dry skin may be, it is a sign of barrier dysfunction. There are different factors that can play a role in barrier dysfunction, but in short it doesn’t keep water in and allergens and irritants out!

How do we repair our barrier and keep our skin healthy and soft? Applying a good moisturizer frequently is critical.

However, the term moisturizer is a marketing term and not all moisturizers are created equal.

I have patients tell me all the time, well I apply my Bath and Body works hand lotion daily and then we go on to have the discussion that the term moisturizer is a marketing ploy and they are not all created equal.

Step 1 ; picking a good moisturizer

• Ointments are better than creams, and creams are better than lotions. This comes with a caveat, you have to like the feel of what you put on or else you won’t use it frequently enough. Don’t smear Vaseline all over your body and dread it, just remember in general the thicker (higher oil content than water and alcohol content) the better.
• Look for the terms, emollient and humectant
• Products should contain ceramides
• Products should not contain fragrances and soaps
• Good ingredients include; Urea, petrolatum, dimethicone, etc..

There are many different brands you can find at your grocery store with these tips in mind. If you do have very sensitive skin that is prone to eczema then my favorite is the Vanicream line of products because it is in my opinion the most hypoallergenic product out there.

There are also some prescriptions medications that repair and protect the skin barrier that many patients have had less eczema flares with and you can talk with your doctor about those.

Step 2; Frequency of application

            –The more you use it the better. Your moisturizer should be applied at least twice a day with one of the applications being immediately following showering when your skin has highest absorption.

Other tips to avoid further drying out your skin this winter

• Frequent washing, especially in really hot water
• Hard water, which increases skin pH
• Soaps and antiseptics
• Extreme temperatures
• Excessive chlorine in pools and hot tubs

Basically, if you want your skin silky smooth at all times, move to Hawaii and avoid the low humidity, wind and cold that comes with Utah winters!

Lindsey Smart Smith PA-C

No, don’t rub fruit on your face.   I’ve seen several posts and articles about the benefits of certain foods and about applying them topically on your face to get the benefits of these ingredients.  Why don’t I agree with this?  I’ll tell you, and I’ll start with a metaphor I heard and really like for this.   Imagine walking into a critically acclaimed restaurant run by a celebrated and highly educated chef, barging back into the kitchen, and saying, “Oh, chocolate soufflé? Well, I’ve got an oven and a bar of chocolate right here, I don’t need your fancy kitchen shenanigans.”

Sure, you can make a chocolate soufflé on your own.  And yes, you don’t need to get it from an expensive restaurant for it to be good.   But if you have had no training or even practice in this area, it’s a bit unreasonable to suggest that you’re going to out-cook someone who’s devoted years of their life to the culinary arts.

The same can be said of beauty products. Cosmetic chemists go to school for years so that they can understand the science and make expert products that are effective, safe, and long-lasting.

Home made products are especially not worth it in the case of vitamin C, and vitamin C is the main reason why so many beauty blogs will suggest rubbing these things directly on your skin.  Here’s a just a couple of reasons why:

1. Instability: L-ascorbic acid is very unstable. It’s one of the most effective forms of vitamin C, but it degrades in heat, light, and air.  Stabilizing vitamin C is not always an easy or cheap process.
2. The wrong pH: The skin is slightly acidic, with a pH around 5.5 or 6.5, and mildly acidic products do the best on the skin.  Specifically, Vitamin C penetrates the skin best at an acidic pH and in order to effectively enter the skin, it must be formulated at a pH lower than 3.5. However, a pH too low is going to cause irritation, sun sensitization, and dry skin.

So, these products are formulated by professionals who spend their time researching and developing the coming up with the most effective methods. While something in your kitchen might be readily available and safe, it’s still not likely to work as you intend it to.  When it comes to vitamin C, irritation will probably be the biggest issue, but even if its not.  Without the right pH, a stabilized formulation, and additional ingredients, it won’t even work.

My advice? Let’s be more demanding. Demand more and better research from our cosmeceutical companies.  Require products that have solid scientific evidence to support their efficacy.  And when it comes to home remedies, consider sticking to professionally formulated products that work and won’t be irritating to your skin.

Metaphor and content drawn from several sources. Principally see Futurederm.com Skincare by Natalie Bell.

We are all born with skin, the largest organ, and it plays many vital roles. Most importantly it serves as the physical barrier between the outside world and us. It provides protection against harmful UV rays; it prevents water loss, regulates body temperature and plays a major role in sensory perception.

Infant skin is different than adult skin and it undergoes a significant maturing process the moment after delivery through the first year of life. The development of the skin barrier increases with gestational age, meaning that preterm infant skin is even more fragile. Newborn skin is more susceptible to infections, heat loss, damage from chemicals and heat, and isn’t as effective at keeping things out that are supposed to stay out. I think it is most helpful to think of Infant skin as having a slightly impaired barrier.

How do we care for such fragile skin as it is still developing? Are there products we should use and ones we should avoid? How often should we bathe our babies? Can we prevent our children from having dry or diseased skin in the future?

One thing that I noticed that was different when I gave birth from when my mom delivered me in the hospital is that they do not immediately bathe the baby anymore. This is because of the special coating brand new babies have on their skin called the vernix caseosa. It is a protective coating that develops during the last trimester of gestation. It is composed of water, proteins, sebum lipids and antimicrobial peptides. The coating on the skin surface contributes to a higher skin hydration, a lower skin pH and relates to a reduced heat loss after birth. Basically I wish that protective coating were on their skin forever!

One of the most common diseases in young skin is Eczema, a disease of dry skin. This condition tends to run in families and these kids can also develop two other closely related conditions, asthma and seasonal allergies. While there is no cure for this disease, a recent study performed in the United States and the United Kingdom provides evidence that might be able to help prevent it. The study took hundreds of infants at high risk of developing eczema and showed that that daily full-body moisturizing from birth can prevent eczema.

The exact way that it prevents the disease is not fully understood, but the study proposes that emollients, moisturizing creams and ointments, correct the skin barrier and the early inflammation in at-risk infants by improving skin hydration and reducing skin permeability. This in turn leads to preventing skin dryness and cracking, as well as reducing irritation and allergic reactions. It also stops some infants from developing eczema.

Some skin cleansing tips for babies

• Use Emollient based liquid cleansers that are pH neutral or mildly acidic.
• Avoid cleansing bars or scrubbing brushes that can further damage a fragile skin barrier.
• Although they smell nice, avoid the fragranced body washes. Lavender oil can be allergenic and can further irritate dry skin.
• Limit baths to no more than every other day and bathe in luke warm water.
• Immediately following bath time, apply an emollient based, fragrance free thick moisturizer from head to toe. Moisturizers in pump bottles tend to have more preservatives in them so they will spread easier, but have less of an occlusive effect making them less effective. The thicker the better!!
• Avoid products with excessive ingredients and preservatives like formaldehydes and parabens.
• Some great products are; Cetaphil Baby, Aveeno Baby, Vanicream is one of my favorites and believe it or not good old Vaseline or Aquaphor! For those babies that already have eczema give Robathol bath oil a try.

This is really cool stuff! It literally lends credibility to the title of this post, liposuction in a needle. The product is called Kybella (deoxycholic acid) and with it, a sharper jaw line may be just a few injections away.

The FDA recently approved Kybella for treatment of adults with moderate-to-severe fat below the chin, known as submental fat. This is fairly groundbreaking as kybella is a first-in-class medication. There is literally nothing else on the drug market that is FDA approved to dissolve fat in this manner.

A bit of history:
Compounds like kybella have been injected into the body for many years to try and tighten skin and destroy fat, but this is the first time that a medication like this has successfully undergone the rigorous study and clinical trials to obtain FDA approval.

Kybella is deoxycholic acid, a secondary bile salt, found naturally in the body. Its job in the body is to emulsify or surround fat and help the body absorb dietary intake. When Injected directly into fatty tissue the deoxycholic acid ruptures cell membranes and causes destruction of the fat cells. Once destroyed, those cells can no longer store or accumulate fat.

What is treatment with kybella like?

First, we will clean the skin and mark out the area to be treated under the chin. The area is then typically numbed with either topical or injected numbing medicine such as lidocaine. Kybella is then injected directly into the submental fat pad under the chin. The entire treatment lasts for about 15 min.

In the Kybella studies approximately 70% of patients were getting their desired results in 2-4 treatment sessions, but the treatment can be repeated as necessary to achieve the desired outcome. Treatments in the study were spaced out every 4 weeks, but I think we will find that this is too close together and that waiting closer to 8 weeks in-between treatments will give a more accurate perspective on results.

Since fat cells do not regenerate, once the desired aesthetic outcome is obtained, the need for retreatment at any time is not expected. Even if weight is subsequently gained.

Expected side effects from the treatment include redness, bruising, and swelling. Discomfort, as would be expected from the sensation associated with a bruise, is also common. These last anywhere from 3-7 days on average. Rare side effects noted in the study were all temporary but included difficulty swallowing or nerve injury resulting in an uneven smile for a few weeks.

Overall, I’m very excited about this therapy. It’s new, it’s safe, and it works.

See some before and after pictures below: