Do you remember these days, pass the baby oil and cocoa butter!


I remember in high school when you laid out as much as possible on vacations so you could come back looking like a bronzed goddess! I wish that I was a little smarter back then and took sunscreen and sun protection more seriously, but it’s never too late to start now.

There are two principle ways in which sunscreen blocks UV radiation. The sunscreen either contains compounds that physically block the sun by reflecting the UV rays, or it contains chemicals that absorb the UV radiation before it gets to the skin. They are referred to as physical and chemical blockers respectively.

The UV radiation that reaches the earth’s surface is principally UVA and UVB. The vast majority of UV radiation that reaches our skin is UVA with only a small percentage being UVB. UVA, being that it has longer wavelengths, can penetrate more deeply in the skin, and is not blocked by the glass of a car window. Technically, UVA and UVB do different things to the skin, but both wavelengths cause damage to the DNA, increase the risk of skin cancer, and cause photoaging.

Recently compounds have been developed that are more effective at absorbing a broad range of UV radiation, and sunscreens are now combining chemicals that absorb different portions of the spectrum to create a broad spectrum of protection. Make sure to read the sunscreen and see that it offers “broad spectrum” coverage. Commonly used ingredients that will cover a broad spectrum are avobenzone, and octocrylene.

The most common physical blockers are sunscreens that contain zinc or titanium. Physical blockers are slightly different in that they have always blocked the full spectrum of UV radiation because all they do is reflect the rays. They have been around for a while but they were cumbersome to use initially because the formulations years ago would not rub into your skin. They would simply have to be painted on like a think white paste on the nose. Think of any beach themed movie or TV show from the 80’s or early 90’s. Technology has now dramatically improved the ease and esthetic of their use.

Possibly the most important aspect of sunscreen use is reapplication. Sunscreen does not last for nearly as long as what advertisers would have you believe, and there is no such thing as waterproof when it comes to sunscreen you rub onto your skin. They will all wash off if you’re having fun swimming or sweating. No matter the spf, if its not on your skin it wont work, so remember to reapply every few hours.

People frequently ask for sunscreen recommendations, or about what the best sunscreen is. My answer is the one you use! There are a lot of great sunscreens to choose from and as long as it has an spf of at least 30, good broad spectrum coverage, and you reapply frequently with appropriate amounts, then the rest is just personal preference. There are thick creams, runny lotions, and aerosol sprays, all with a variety of smells and prices attached. Find one that you like and use it.

Our current favorite when it comes to facial sunscreens is the Elta MD UV Clear, with SPF 46. It’s a physical blocker that rubs in clean and smooth and does not leave your face feeling sticky and without an annoying sunscreen smell or residue. The Elta MD daily is a little bit more creamy and also awesome! They don’t pay me to sell their product, but I recommend it to so many people that they probably should.


Easy Sun Tips
– Use a sunscreen with at least SPF 30 that is Broad spectrum and apply every couple hours.

– Avoid mid day sun hours from 10 am- 2 pm if possible when scheduling activities like a hike or a Tee time.

– Wear sun protective clothing with a UPF rating. It really works and believe it or not J crew even has sun shirts!

-Get a moisturizer with SPF so that you can get into the habit of applying daily, even in the dead of winter.
– Wear hats and sun glasses whenever possible. They have so many cute styles that this one is pretty easy and if you are going to be out for awhile the bigger the brim, the better.





Aging is a complex and progressive process, and it is inevitable. One of the easiest and most effective things you can do to keep your skin looking healthy and youthful for longer is to protect it from the sun. Or more specifically, from the spectrum of ultraviolet (UV) radiation which can be either from the sun or from other synthetic sources.

Chronic UV radiation causes a variety of age related changes in the skin. It causes mutations in the DNA of the skin cells. It causes reactive oxygen species that can cause damage throughout the skin cell. It also causes freckles and pigmentary alterations, thinning of the skin, fragile blood vessels, and reduced elasticity. These changes of functionality result in changes in appearance, like wrinkles, uneven color or texture, drooping skin, dilated superficial blood vessels, and an increased pore size.

Collectively these changes in the skin are known as photoaging or sun damage. And the appearance of photoaging in some people can be quite dramatic. There are several interesting pictures floating around on the internet that illustrate the effects of sun damage on physical appearance quite nicely. The included photo is of  a truck driver with decades worth of sun exposure to the left side of his face, while the right side remained relatively protected in the truck. Notice the difference in drooping of the skin, the depth of the wrinkles.

One sided sundamage in truckdriver Bill Elliot

While photoaging happens to some degree in all skin types, it is particularly striking in those with lighter skin. Lighter skin lacks the natural protection that skin pigment provides and is inherently more susceptible to UV damage.

So this is where I make a plug for sunscreen. And try to dissuade you from tanning on a regular basis. Using regular sun protection guards the skin against the damage caused by UV radiation. Not only will this help protect your skin from developing skin cancer, but it will also keep it looking young and health for a longer time. Use sun protection!

The stuff that lives on us!

A diverse collection of microorganisms, bacteria, fungi, viruses, and other bugs live on the human skin. In fact, in our bodies microbial cells are reported to outnumber our own 10 to 1. This group of resident flora and fauna makes up what we refer to as the “microbiome”, and it’s no secret that these little guys can have a big effect on your health and immune system.

The human microbiome is both diverse and dynamic, varying from person to person and changing throughout life’s course. And it is becoming increasingly apparent that the microbiome is a prime target for manipulation and treatment in various conditions. While this knowledge is not particularly new, our methods for investigating are. New sequencing technologies have revolutionized the way we can study microbial communities. This gives us a better understanding of the nature and composition of the healthy skin microbiome, and we are learning more about how it is disturbed in various disease states. This puts the development of exciting new therapies targeting these bugs on the horizon.

What is the role of the microbiome in aging skin?

This is unclear, but postulating is always fun. We all know or have heard about the benefits of probiotics for the GI tract. There is a healthy microbial balance in the gut that is anti-inflammatory and it is foreseeable that certain metabolites released by the natural bacteria on the skin provide a similar anti-inflammatory effect helping to prevent discoloration, sun damage, and wrinkle formation.

Too much sweating? MiraDry could be your cure.

Excessive sweating beyond that which is required to regulate body temperature is medically termed hyperhidrosis. It is estimated to affect over 3% of the US population, which is quite common as far as medical conditions go. And according to quality of life studies, few medical conditions that are this common have as significant an emotional and social burden as hyperhidrosis. The most commonly affected body sites include palms, soles, armpits, face and scalp. These are also areas that are naturally high in sweat gland density.

Hyperhidrosis can be primary or idiopathic, which means it occurs without any apparent cause. Or it can be secondary, meaning that it is the result or side effect of something else like medications, hormonal changes, or other illnesses. It can also be localized to one area of the body, just on the hands for example, or it can be generalized with increased sweating from many areas of the body together. When hyperhidrosis is secondary it is usually generalized, affecting many areas of the body.

How do you know if you have primary hyperhidrosis? Check out the diagnostic criteria:

  1. You have Excessive sweating of 6 months or more located in axillae, palms, soles or craniofacial region
  2. There is no apparent secondary cause, such as medications, endocrine, or neurologic disease.
  3. You also have two or more of the following characteristics:
  • Symmetric, affecting both sides of the body.
  • Not present during the night
  • Episodes occur at least weekly
  • Onset of the problem before the age of 26
  • There is a family history of excessive sweating
  • The sweating is so much that it impairs normal daily activities

How do we treat it?

There are various treatments including topical solutions, systemic medications, and a variety of procedures. I’ll review a few of them very briefly.

Topical treatments are the first thing to try. There are several possible topical options, but the most common are prescription strength medications with up to a 20% Aluminum Chloride solution. These are often cheap and quite effective, but occasionally irritating to the skin.

Iontophoresis is another option, most often used for hyperhidrosis affecting just the palms or the soles.  It is a technique that involves immersion of the palms or soles in small, electrode-containing plastic trays with tap water. A very mild electric current is applied. This, we think, helps force sodium and other ions from the water into the sweat gland openings, forming plugs that restrict release of sweat from the ducts. Side-effects including minor discomfort during treatment and skin irritation such as burning, tingling and erythema rarely occur. The amount of time required for therapy is sometimes bothersome to patients, as each session is given over 20 min and it is necessary to treat at least a few times a week in order to maintain improvement.

Botox, Botulinum toxin, is a great way to treat focal areas of hyperhidrosis. It is a neuromodulator that works to stop nerves from firing by blocking presynaptic acetylcholine release. Since the nerves that activate the sweat glands are controlled by acetylcholine release, Botox does a nice job at decreasing sweat gland production. Botox injections are less invasive than surgical procedures and provide longer-lasting results than topical therapies. The effects last for 4–9 months on average and are associated with a very high satisfaction rate among patients.

This brings me to microwave energy, the motivation for the post. It is an exciting new therapy for excessive underarm sweating. The technology is called MiraDry, and there is nothing else out there like it. MiraDry uses microwave technology to permanently destroy the sweat glands in the armpits, and it is getting a lot of press these days in the cosmetic medical literature. It is approximately a one-hour procedure done in the clinic under local anesthesia to both armpits. Up to 80% of the sweat glands are destroyed after just one treatment, but two treatments appear to be required to achieve optimal results. Biopsies performed on skin treated up to one year previous have shown marked decrease in sweat glands, and since sweat glands are thought to not regenerate, this seems to support the company’s claims of long-term results. Side effects include transient swelling, discomfort and numbness, as well as redness, bruising, and partial underarm hair loss. Of course, evolving data regarding safety, therapeutic settings, efficacy, side effects and long-term follow-up will continue, as this treatment option is relatively new.

But the patients that I’ve treated are extremely pleased with this approach and I love being able to offer a treatment with such positive and potentially permanent results.