Category: Uncategorized

Our very own, Dr. Benjamin Barankin was recently quoted in The National Post about dry skin – products and preventatives.

During the colder months, our bodies are often covered in layers of clothes. Then during the summer, we shed some layers and our skin makes a guest appearance. As we sport shorts, tanks and sandals, we’re sometimes surprised by the state of our skin. 

It can be off-putting when legs are so dry they look like the Sahara desert floor, cracking in the heat. Or when elbows are so rough they can injure others. Or when heels split open and start bleeding. Problems that many dry-skinned humans have to deal with on a daily basis.

In order to cure dry skin, and prevent it, we reached out to Dr. Benjamin Barankin. Dr. Barankin is a Toronto dermatologist and medical director of Toronto Dermatology Centre. He’s already helped us find the best sunscreens and understand basic skincare, and now he shares his expertise in our quest to have happy and healthy skin.

What can cause dry skin?

“Dry skin has lost its moisture. It can appear as dry, but also dull, scaly or flaky, and sometimes itchy. If it is prolonged, it can result in eczema (red, itchy, sometimes weepy skin),”  says Dr. Barankin.“It can be due to aging, or medications (e.g. acne treatments, blood pressure pills, diuretics, statins for cholesterol), or long dry winters, and often has a genetic component too.”

What can cause cracked heels?

“As skin dries, it shrinks which can cause cracking. Some cracks can be deep, and then become sore or even bleed,” shares Dr. Barankin. It can even get medical. “Some people have cracking of heels because they have an actual skin condition like foot fungus (tinea pedis) or psoriasis or eczema.”

How do I know if I should see a dermatologist or use over-the-counter products? 

“For dry skin or cracked heels, definitely worth trying some over-the-counter products first. Also, being more mindful to moisturize immediately after bathing, as well as having a cool-mist humidifier on in the wintertime,” says Dr. Barankin. 

“And minimizing exposure to the elements (e.g. wearing gloves, hat, scarf etc., or avoiding going outdoors on cold or windy days). Using less harsh soaps is important (like CeraVe Hydrating Cleansing Bar or Dove sensitive skin bar) too, and reducing friction from towels by pat drying instead of rubbing.”

Are there any home remedies that are effective to treat dry skin?

“Lots of different products worth trying. In general, the greasier the better (ointments and balms are best, then creams, lotions the least),” says Dr. Barankin. Adding that “Urea is a useful ingredient and should be used at higher concentrations for hands and feet.” 

Dr. Barankin also suggests the following possible ingredients for home remedies (many are raw ingredients, so use with caution):

• Glycerin
• Shea butter
• Colloidal oatmeal 
• Dimethicone
• Hyaluronic acid
• Ceramides
• Niacinamide (it’s relatively new and seems to be effective)
• For thick and dry heels, various acids such as lactic acid or salicylic acid could be effective

Credit: By Randi Mann, nationalpost.com

This past weekend, our very own Dr. Max Sauder was pleased to take part in the annual Canadian Dermatology Association (CDA) Virtual Conference 2021. Dr. Max Sauder was very honoured to speak to and educate other physicians about: Managing Skin Toxicities of Anticancer Treatments. 

At the end of this symposium, participants were able to: 

•    Describe the different modalities for the treatment of cancer in Canada 

•    Identify the most common skin reactions from immunotherapy, targeted therapy and radiation therapy 

•    Discuss how skin reactions from oncology treatments may be managed 

To learn more about CDA conferences in the future click here. 

Nail biting can ruin your nails, damage your teeth and spread bacteria. Here’s how to tame the habit.

Dear Asking for a Friend,

My 18-year-old daughter bites her nails all the time, often until the nail is below the skin. She says she can’t help it, especially when she is stressed or nervous. We have tried putting a bitter apple polish on them that tastes bad, but that hasn’t worked. I am also worried that she is exposing herself to germs and bacteria. Any suggestions as to how I can help her to stop?

Signed, Stubby Nails

Dear Stubby Nails,

It’s not unusual for children and adolescents to use repetitive behaviours to help soothe themselves. According to experts, nail biting may serve as a distraction and help bring about feelings of emotional balance and calm.

“It’s acceptable to suck the thumb as a child, but once we’ve retired it, we need a replacement behaviour that’s soothing,” explains Joseph Eliezer, a registered psychotherapist, clinical counsellor and author based in British Columbia. “Nail biting or picking, to the unconscious, is like removing a hard surface (exterior) so that difficult emotions (interior) can be released.”

Research shows that roughly 20 to 30 per cent of people bite their nails, including up to 45 per cent of teenagers. Factors such as boredom, nerves or anxiety may trigger nail biting, but there is also evidence that suggests that children whose parents bite their nails may be more prone to developing the habit. It can also occur as a result of working on difficult tasks, according to some studies, and in rare cases, nail biting can be a side effect of medication.

But whether it’s boredom or nerves, it’s a tough habit to break because of the way our brains are wired. Consider that it takes just 66 days to form a habit, and that anything that may feel soothing or enjoyable causes the brain to release dopamine. This is a good thing except that when we feel pleasure or relief as a result of an action, we want to experience more of it. So you can see how nail biting can become an efficient, automatic and an addictive response to a specific trigger or stressor.

The proper medical term for nail biting is onychophagy and the good news is that it doesn’t cause serious health complications, but it may lead to dental problems, including damage to front teeth and the enamel. Exposure to germs and bacteria that end up on the hands and into the mouth may also lead to more colds and flu, and in some cases, it may cause infection.

“Nail biting, especially if you’re damaging the cuticle or pulling on a hangnail can result in a skin infection around the nail, most commonly by Staphylococcus or Streptococcus bacteria,” says Dr. Benjamin Barankin, Toronto dermatologist and medical director of Toronto Dermatology Centre. “If caught or treated early, a topical antibiotic can work well, and if it progresses, oral antibiotics and rarely, IV antibiotics may be required.”

Interrupt and replace
Eliezer says that in order to stop a behaviour, it needs to be interrupted and replaced with something else that soothes. This is part of a three-step process that starts with becoming more aware of the habit and making a conscious effort to stop doing it. Then substituting the behaviour with another action, such as getting a drink of water, taking a walk, taking deep breaths or watching TV.

“Literally, almost any substitute to the behaviour that you think will work, will work,” suggests Eliezer. “The trick is to teach the mind, or the self, not to engage in a behaviour that a person would ultimately like to stop.”

Other strategies include regular manicures — perhaps your daughter may be less likely to bite her nails if they look nice. She could also try covering her nails with tape, or wearing gloves.  might regular manicure might motivate your daughter to stop biting her nails. If her nail biting habit continues, or becomes worse or interferes with her daily functioning, a behavioural therapist can offer additional support.

Credit: By Maja Begovic, healthing.ca

If you have any of the following benign lesions or conditions, a referral from a doctor is not required for assessment.

• Excessive sweating (Hyperhidrosis)  – The underarms, palms, soles, scalp and forehead, and groin may be safely and effectively treated with Botox^®.
• Botox for TMJ & migraines – In 2021 FDA approved Botox® as a preventive treatment for chronic migraines. And in 2012 a study found that Botox could significantly decrease pain and increase mouth movements.
• Moles – is a common benign skin growth composed of pigment cells called melanocytes.
• Skin tags – are harmless, fleshy, dangling skin growths that can be removed.
• Age spots or liver spots – are flat, brown areas given the medical term “lentigo” or “lentigines.”
• Angiofibroma – are benign 1-5mm fleshy to pink small bumps that are very common on or near the nose and look like small moles.
• Cherry angiomas – are harmless, small, red (cherry red) raised bumps created by dilated blood vessels.
• Cysts – epidermoid cysts, also commonly referred to as “sebaceous cysts”, form as a result of the growth of cells within area of the skin.
• Dermatofibroma – is a common benign skin lesion, thought in many cases to arise after a minor injury such as an ingrown hair or insect bite.
• Lipoma – is a benign growth made up of fat cells. It develops slowly deep under the skin in the subcutaneous tissue. 
• Pearly penile papules (PPP) – are common flesh-coloured and benign growths found on the circumference of the rim of the tip of the penis.
• Seborrheic keratosis – are brown or black raised, often crusted spots or wart-like growths.
• Syringomas – are non-symptomatic flesh-colored to yellow small spots. The surface is either flat-topped or round.
• Xanthelasma – are soft yellow spots occurring most commonly on the eyelids (upper, lower or both). 

 

With summer just around the corner, it’s time to embrace flirty skirts, khaki shorts and bathing suits. But is your skin ready? Here are 5 skin problems we can help you resolve:

1) Keratosis pilaris

For treatment, best to use topical exfoliates containing alpha-hydroxy acid, lactic acid, salicylic acid or urea moisturize to soften dry skin while helping to loosen & remove dead skin cells. Certain types of KP may involve severe redness & inflammation which can be successfully treated with Laser Genesis. Also, the Profractional laser can be used to break up the skin in the affected areas, thus eliminating the plugged follicle. 

2) Stretch marks and scars

Toronto Dermatology Centre offers both invasive & non-invasive treatments which can help fade and reduce your stretch marks and scar from injury, surgery and/or acne. Such as Profractional laser, microneedling with PRP, chemical peels and microdermabrasion. We also carry a variety of skincare products that can help elevate your results.

3) Décolletage, neck and jawline

Morpheus8 & Forma is our newest anti-aging and skin-tightening treatment which combines radiofrequency with microneedling. CoolSculptng and Belkyra are also ideal treatments for double chins. We can help you reverse the signs of sun damage, restore skin laxity and recontour your neck/jawline. 

4) Spider leg veins

Sclerotherapy is a popular method of eliminating spider leg veins. A solution is injected into the veins, leading to fading of the vessels over several weeks. Treatments are quick, safe and relatively painless. Most patients require 3-5 sessions for optimal results. We also house the Excel V Laser which can target smaller spider veins on both the face and legs. 

5) Body/Back acne 

Besides our face, our body and back are the prime real estate for acne. At TDC, our team of dermatologists and medical estheticians can together help create a treatment plan tailored to your needs. Ranging from chemical peels, microneedling to lasers. On top of that, we carry exclusive skincare products with medical-grade ingredients that can help target and resolve your acne problems. 

Come in for a free skin consultation. We can’t wait to see you!

Our very own Dr. Benjamin Barankin recently provided National Post with the inside scoop on sunscreens and sun protection.

---

As soon as the sun flashes us with some rays, Canadians immediately take to the outdoors. We know that skincare is important, but proper sun protection is not as obvious as smearing some lotion on faces in the morning. 

We spoke with Dr. Benjamin Barankin, Toronto dermatologist and medical director of Toronto Dermatology Centre, to fully understand how to navigate skin protection. 

“UVB rays cause sunburns (and tanning; in severe cases blistering); traditional sunscreens are best at blocking UVB. UVB is connected to the [sun protection factor] SPF, [and they] don’t penetrate glass,” Barankin says.

Do we need to protect ourselves from both?

Yes. Dr. Barankin emphasizes that it’s critical to protect from both and put extra emphasis on blocking out those UVA rays. However, not all sunscreens protect from UVA and UVB rays.

What sunscreen brands do you recommend?

Not only do we have to focus on getting the right sunscreen product, but we also need to ensure we’re using it correctly; reapplying every three to four hours. Dr. Barankin says we want a high-quality broad-spectrum sunscreen that is easily absorbed and has minimal or no residue (and minimal to no fragrance, which can irritate the skin…this was a twist…no more smelling like the beach). 

Do we need a different face and body sunscreen?

Dr. Barankin says that if you’re acne-prone, then go with a face sunscreen; they’re less comedogenic (fancy word for acne-causing). He stresses that it’s important to “find something you like and you’ll use and keep it handy everywhere that you might need it.”

Does sunscreen block us from absorbing vitamin D from the sun?

Yes, sunscreen slightly blocks vitamin D.

“In Canada, most people are deficient in vitamin D anyways due to long winters, and others have harder times absorbing it if elderly or darker skin or if wearing lots of clothes for religious reasons. Best to use sun protection, and take vitamin D as a supplement (and in your milk and other fortified foods),” Barankin shares.

Final thoughts

“The importance of sun avoidance (e.g. doing your outdoor work or exercise before 10 a.m. or after 4 p.m. when the sun is weaker), wearing a good wide-brimmed hat (to cover nose and ears, common locations for skin cancer), and sunglasses (reduce cataracts caused by UV light). Seek shade where possible,” Barankin reminds us.

He recommends we, “Find an elegant and affordable sunscreen, and reapply it after towelling/getting wet/sweating or every three to four hours if out and about. Make sure you apply enough sunscreen too! — most people only put on about a half of what they need to…so, put on what you normally do, and then do it again!” 

Credit: Randi Mann, National Post

 

Over the past few months, we have received some frequently asked questions from patients, so today’s blog will address these questions.

1. What do I do if my skincare product expired?

In Canada, our expiry dates are significantly shorter than the same product, made at the same time from the same batch in the States. Our guidelines are stricter, but the reality is that if you have a product that has recently expired, use it. Products aren’t milk, they won’t spoil. Over time, the efficacy may slightly diminish, and of course, I wouldn’t suggest using a skincare product that expired ages ago, but a few months is nothing to be concerned with. If the product has changed colour or has a new odour, or was left out for hours in the heat or with the cap left open, those would be other reasons to toss that product.

2. How do I manage enlarged pores?

Pores enlarge generally in the T-zone, where most of the oil is produced on the face. The pores fill with oil(sebum) and eventually stretch. You can’t change the composition of your skin, but keeping it clean, exfoliating (but not over exfoliating…everything in moderation!) and facials to extract will help to prevent stretching. As we age, we lose collagen and density, causing the skin to fall, and therefore the pores may appear larger. ZO Instant Pore Refiner and retinol products will help to polish the skin and prevent the skin from sagging. Glycolic acid in a cream form or doing chemical peels will also reduce the appearance of large pores.  The new SkinEssentials MD Texture Perfector will work on pore size and work towards that “no pores” skin we crave. My personal favourite? Microneedling!!! Profractional laser is also very effective, and both treatments will take several appointments to get good results.

3. If I have grey or silver or white hair, how do I remove it?

Lasers look for colour so that their energy can be absorbed into it. Without colour, the energy has nowhere to go. Although there is still often some improvement with laser & light-based devices, the hair reduction is not nearly as dramatic as for darker hair. Other options include: electrolysis and waxing, or prescription Vaniqa cream.

4. How can I avoid getting prominent leg veins?

Although developing prominent leg veins (e.g. vericose, spider) can be genetic, there are some ways to reduce or prevent the severity of them. Don’t sit with legs crossed or apply extended amounts of pressure on the legs. Wear sunscreen and try to keep skin cool. Be fit – the trimmer you are, the less pressure on the legs. Compression garments/socks/stockings will also help to constrict the vessels to prevent breakage. Come in for a consult, there are some good options for treatment (e.g. lasers, sclerotherapy).

5. What are some good creams or serums for giving my skin a nice glow?

Using retinols and glycolic products will help keep the skin smooth as well as to prevent aging. My favourite is ZO Wrinkle and Texture Repair and SkinMedica AHA/BHA cream, both applied at night time. For daytime, The HA5 from SkinMedica applied under your moisturizer in the morning will instantly create not only a glow, but really hydrate and keep the skin plump. Our vitamin C serums will also give the skin a glow as well as protect the skin all day long. Adding Skin Essentials MD Hydraquench every morning provides instant glow and long-term hydration, slowing down the signs of aging skin.

6. How can I minimize scarring after a surgical procedure?

Your doctor may suggest a post-surgery repair product, usually silicone based. When you see us on the fourth floor, we will explain how to use it and for how long. If the scar is in an exposed place on your face or body, sunscreen is mandatory, as hyperpigmentation is common on unprotected scars and a wound/scar doesn’t heal as well if exposed to too much sun. Once the scar has healed completely, your medical esthetician can reassess the results and offer options to improve the scar, if needed. We have different and effective treatments for a very fresh scar (e.g. less than 6 weeks) as compared to an older scar (e.g. older than 6 weeks). We also have laser options and other treatments if scars are still red after a few months, or if there are changes in elevation of the scar.

Please send questions to [email protected] and I would love to hear any questions you have about any & all skin care topics.

~ Sheri Roselle, Medical Esthetician at Toronto Dermatology Centre

There has been a lot of hype recently regarding treatments for melasma. Melasma, which is hormonally driven and affects women substantially more than men, appears as pigmented “islands” on the face. Lesions look typically like larger brown flat freckles, tend to be symmetrical, and often affect the cheeks, forehead and the “moustache” area. It has been called “pregnancy mask” when it develops in and around the time of pregnancy, but can be prompted by any hormone fluctuation including taking the birth control pill.

Although melasma is caused due to changes in hormones for some patients, exposure to sun, tanning salons or heat will exacerbate the condition. Proper sun protection and avoiding overheating may help to prevent the melasma from becoming more intense, but often will not fade entirely what has already surfaced. Patients often find, however, that the melasma is lighter in the winter due to being less exposed to sunlight.

I first heard of Tranexamic acid a few years ago when SkinCeuticals decided to create a pigment lightening serum that could rival the effects of Hydroquinone (HQ). They developed Discolouration Defense, with 3% tranexamic acid, kojic acid and niacinamide, a combination that could equal the reduction of pigment associated with HQ. And it absolutely does work!

But, for some patients melasma is very deep and very stubborn. Some melasma forms in the epidermis, or top layer of the skin. For many though, it forms in the dermis, the underlying layers, which are much harder to treat. In others, it affects both the epidermis and dermis.

Recent medical case studies have shown that applying 4mg tranexamic acid during microneedling is as effective as 4% HQ (which is no longer available OTC in Canada).  Medical grade Vitamin C was also used in a split side comparison study done with 30 women and, although reduction was evident in both sides, the side with tranexamic acid had superior results.

It has been suggested to treat a minimum of 3-6 times, with a 1 month window between treatments. Patients will see some results in as little as 4-8 weeks, but additional treatments can continue to improve as a plateau was not recorded during the studies provided.

What does all of this mean? Well, when it comes to microneedling there are multiple ways to achieve results with different conditions or skin concerns. Regular microneedling can get a boost from PRP (platelet-rich plasma), RF (radiofrequency) and the addition of Vitamin C or Tranexamic acid.

What this also means is that there is a new hope when dealing with melasma. We know that melasma can be chronic in many cases, but if we can find ways that reduce the melasma or even make it go away at times, then the quality of life is much more pleasant for the patient. Melasma can make a patient feel insecure. It looks “dirty” and sometimes even the most intense make up can’t cover it.

With these current medical studies in mind, we have been sourcing out the best quality tranexamic acid to begin treating our melasma patients with microneedling. For at home use, the Discolouration Defense is a perfect pairing to our clinic treatments. Other good treatment options for melasma include: chemical peels, dermamelan, silkpeel microdermabrasion, and the at home treatments Lytera 2.0 and ZO Pigment Control.

Heads up melasma patients!! This new addition with microneedling may be the best new thing on the market for your concerns. And here at TDC, we will be offering our version in the very near future! Get a head start with the Discolouration Defense now. It can be found in our Cosmetics Clinic or at our online e-boutique.

 

~ Sheri Roselle, Medical Esthetician at Toronto Dermatology Centre