Stress & Skin, brought to you by The American Academy of Dermatology

How the Mind Matters to Your Skin

How we feel on the inside could be affecting how we look on the outside. In fact, studies link factors that impact our emotional well-being — such as stress, depression and anxiety — to an increase in skin, hair or nail problems. Dermatologist and clinical psychologist Richard G. Fried, MD, PhD, FAAD, of Yardley, Pa., explains the reciprocal relationship between feelings and appearance:

Psychodermatology Interventions

• Stress can manifest itself on one's appearance in many ways, but primarily by making the skin more sensitive and more reactive.
  • For example, stress can make psoriasis or rosacea worse, result in acne lesions that are more inflamed and more persistent, cause brittle nails and ridging of the nails, cause hair loss, cause or worsen hives, and cause excessive perspiration.
  • Stress also is a known trigger or can be a worsening factor for fever blisters, psoriasis, seborrheic dermatitis and has even been shown to impair skin barrier function and dehydrate the skin — allowing more irritants, allergens, and infectious agents to penetrate the skin and cause problems.
• Beyond the direct physiological effects of stress, patients under stress also tend to neglect or abuse their skin. For example, they often lack the energy and motivation to adhere to their skin care regimens, and there also might be signs of stress-related behaviors — such as scratching, pulling or rubbing — that can exacerbate problems.
• Traditional dermatologic therapies should be used in conjunction with appropriate stress management therapies to successfully treat stress-related dermatologic conditions.
  • When dermatologists treat both the skin and stress, the skin often clears more quickly and completely as the influences of stress are diminished. This, in turn, can help decrease a patient's overall anxiety level, and the patient may start to feel better about how they look and how they feel emotionally.
• On a microscopic level, stress reduction can decrease the release of pro-inflammatory stress hormones and chemicals. For example, release of neuropeptides (or stress chemicals released from the nerve endings) can be reduced with stress management techniques. This often results in skin that looks and functions better.
  • These interventions can reduce blood vessel over-activity, resulting in less blushing or flushing.
• With accurate diagnosis by a dermatologist, effective treatments improve the appearance and function of the skin. This alone can substantially reduce patients' stress and improve their skin, hair and nail conditions. However, if stress is clearly interfering with patients' overall well-being and ability to cope, simultaneous stress management interventions are warranted. In some instances, referral to a mental health professional may be necessary.

Cosmetic Interventions

• While skin rejuvenation procedures have been shown to significantly improve a person's outward appearance, studies suggest these types of cosmetic interventions also can have positive effects on how people feel and how they function.
  • When people feel more attractive and more confident in their appearance, they tend to perform better in other areas of their lives — in their work, family life, social life, and marriage or personal relationships.
  • Under the right circumstances, cosmetic procedures can be a powerful ally, but it's important for patients to understand that these procedures are not a panacea.
• In a 2008 study designed to measure the positive ripple effects of botulinum toxin injections on other aspects of patients' lives, Dr. Fried found that patients treated with botulinum toxin clearly experienced substantial benefits. His key findings include:
  • 29 percent reported feeling less anxious
  • 36 percent said they feel more relaxed
  • 49 percent were more optimistic
• A previous study conducted by Dr. Fried evaluating the clinical and psychological effects of the use of alpha hydroxy acids (AHAs) found that patients demonstrated significant improvements in facial skin tone and fine wrinkling, and reported satisfaction with their physical appearance and the quality of their interpersonal relationships.

For more information on the effects of stress on skin, hair and nails, visit the American Academy of Dermatology's website at www.aad.org.

November 2008

What is used in the Iderm Treatment?

The Iderm Treatment

To prep the skin I start with a process called a Moisture Pack where I place pieces of fabric that have been soaked in Dermaculture’s Yucca Solution. This solution is derived from the Yucca plants of the southwestern desert, and is an excellent facial cleanser and is also anti-inflammatory. After placing the fabric on the face I then cover the face with an infrared heat dome or "dry heat" for about 10 minutes.

Yucca is high in vitamins A, B and C and contains potassium, calcium, phosphorus, iron, manganese and copper which make it very soothing to the skin, bones and muscles.
The ingredients are over 95% Yucca with stabilizers.

This treatment helps to cleanse the walls of the pores, making it ideal in preparing the skin for extractions.

After extractions I then wrap the skin with cotton and fabric that has been soaking in Dermaculture’s Positive Solution.

This is used to treat acne, age spots, rosacea and psoriasis. This will also give a more youthful glow to the skin, and is beneficial to all skin types.

The Positive Solution is made from a perfect balance of zinc sulfate (Zinc sulfate is used to destroy harmful micro-organisms on the skin and also for its astringent action), citric acid (Vitamin C) and epson salts. The ingredients are very rich in vitamins and minerals. These ingredients work together to increase oxygen, hydration and circulation. The solution is antibacterial and aids in detoxification. It promotes healing, stimulates skin renewal and collagen growth.

The Iderm Treatment is highly recommended before surgical procedures to help prepare the skin for surgery and after surgery to help with the healing process and to prevent scarring.

For more information about this awesome skin treatment visit my website at www.dermaspace.com.

Skin Cancer Facts

Skin Cancer Facts – provided by The Skin Cancer Foundation

GENERAL

• Skin cancer is the most common form of cancer in the United States. More than 3.5 million cases in two million people are diagnosed annually.³⁷
• Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.³
• One in five Americans will develop skin cancer in the course of a lifetime.²⁶
• Basal cell carcinoma (BCC) is the most common form of skin cancer; an estimated 2.8 million BCCs are diagnosed annually in the US.³⁸ BCCs are rarely fatal, but can be highly disfiguring if allowed to grow.
• Squamous cell carcinoma (SCC) is the second most common form of skin cancer. An estimated 700,000 cases are diagnosed each year in the US,³⁹resulting in approximately 2,500 deaths.²
• Basal cell carcinoma and squamous cell carcinoma are the two major forms of non-melanoma skin cancer. Between 40 and 50 percent of Americans who live to age 65 will have either skin cancer at least once.⁷
• In 2004, the total direct cost associated with the treatment for non-melanoma skin cancers was more than $1 billion.¹⁴
• About 90 percent of non-melanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun.³⁰
• Up to 90 percent of the visible changes commonly attributed to aging are caused by the sun.¹⁶
• Contrary to popular belief, 80 percent of a person's lifetime sun exposure is not acquired before age 18; only about 23 percent of lifetime exposure occurs by age 18.⁸

Lifetime UV Exposure in the United States
Ages	Average Accumulated Exposure*
1-18	22.73 percent
19-40	46.53 percent
41-59	73.7 percent
60-78	100 percent

*Based on a 78 year lifespan

MELANOMA

• The vast majority of mutations found in melanoma are caused by ultraviolet radiation.³⁶
• The incidence of many common cancers is falling, but the incidence of melanoma continues to rise significantly, at a rate faster than that of any of the seven most common cancers.²¹
• Approximately 68,720 melanomas will be diagnosed this year, with nearly 8,650 resulting in death.³
• Melanoma accounts for about three percent of skin cancer cases,³¹ but it causes more than 75 percent of skin cancer deaths.³²
• Melanoma mortality increased by about 33 percent from 1975-90, but has remained relatively stable since 1990.²¹
• Survival with melanoma increased from 49 percent between 1950 and 1954 to 92 percent between 1996 and 2003.²¹
• More than 20 Americans die each day from skin cancer, primarily melanoma. One person dies of melanoma almost every hour (every 62 minutes).³
• The survival rate for patients whose melanoma is detected early, before the tumor has penetrated the epidermis, is about 99 percent.³⁴ The survival rate falls to 15 percent for those with advanced disease.³
• Melanoma is the fifth most common cancer for males and sixth most common for females.³
• Women aged 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer.³
• Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for adolescents and young adults 15-29 years old.¹⁸
• About 65 percent of melanoma cases can be attributed to ultraviolet (UV) radiation from the sun.³⁰
• One in 55 people will be diagnosed with melanoma during their lifetime.¹⁹
• One blistering sunburn in childhood or adolescence more than doubles a person's chances of developing melanoma later in life.⁴
• A person's risk for melanoma doubles if he or she has had five or more sunburns at any age.⁵

MEN / WOMEN

• The majority of people diagnosed with melanoma are white men over age 50.¹⁹
• Five percent of all cancers in men are melanomas; Four percent of all cancers in women are melanomas.³
• Contrary to popular belief, recent studies show that people receive a fairly consistent dose of ultraviolet radiation over their entire lifetime. Adults over age 40, especially men, have the highest annual exposure to UV.⁸
• Between 1980 and 2004, the annual incidence of melanoma among young women increased by 50 percent, from 9.4 cases to 13.9 cases per 100,000 women.³⁵
• The number of women under age 40 diagnosed with basal cell carcinoma has more than doubled in the last 30 years; the squamous cell carcinoma rate for women has also increased significantly.⁹
• Until age 39, women are almost twice as likely to develop melanoma as men. Starting at age 40, melanoma incidence in men exceeds incidence in women, and this trend becomes more pronounced with each decade.¹⁷
• One in 39 men and one in 58 women will develop melanoma in their lifetime.³
• Melanoma is one of only three cancers with an increasing mortality rate for men.¹⁷

INDOOR TANNING

• Ultraviolet radiation (UVR) is a proven human carcinogen, according to the U.S. Department of Health and Human Services.¹⁰
• Frequent tanners using new high-pressure sunlamps may receive as much as 12 times the annual UVA dose compared to the dose they receive from sun exposure.¹⁰
• Nearly 30 million people tan indoors in the U.S. every year¹²; 2.3 million of them are teens.¹⁵
• On an average day, more than one million Americans use tanning salons.²²
• Seventy one percent of tanning salon patrons are girls and women aged 16-29.¹³
• First exposure to tanning beds in youth increases melanoma risk by 75 percent.¹¹
• People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.²⁰
• The indoor tanning industry has an annual estimated revenue of $5 billion.¹⁵

PEDIATRICS

• Melanoma accounts for up to three percent of all pediatric cancers.²⁴
• Between 1973 and 2001, melanoma incidence in those under 20 rose 2.9 percent.²⁸
• Melanoma is seven times more common between the ages of 10 and 20 than it is between 0 and 10 years.²³
• Diagnoses - and treatment - are delayed in 40 percent of childhood melanoma cases.²⁴
• Ninety percent of pediatric melanoma cases occur in girls aged 10-19.²³

ETHNICITY

• Asian American and African American melanoma patients have a greater tendency than Caucasians to present with advanced disease at time of diagnosis.⁶
• The average annual melanoma rate among Caucasians is about 22 cases per 100,000 people. In comparison, African Americans have an incidence of one case per 100,000 people. However, the overall melanoma survival rate for African Americans is only 77 percent, versus 91 percent for Caucasians.²¹
• While melanoma is uncommon in African Americans, Latinos, and Asians, it is frequently fatal for these populations.⁶
• Melanomas in African Americans, Asians, Filipinos, Indonesians, and native Hawaiians most often occur on non-exposed skin with less pigment, with up to 60-75 percent of tumors arising on the palms, soles, mucous membranes and nail regions.²⁵
• Basal cell carcinoma (BCC) is the most common cancer in Caucasians, Hispanics, Chinese, and Japanese, and other Asian populations.²⁵
• Squamous cell carcinoma (SCC) is the most common skin cancer among African Americans and Asian Indians. ²⁵
• Among non-Caucasians, melanoma is a higher risk for children than adults: 6.5 percent of pediatric melanomas occur in non-Caucasians.²³

Sources

1. "Squamous Cell Carcinoma." MayoClinic.com. 8 March 2007. 15 April 2008. Link.

2. "Squamous Cell Carcinoma." American Academy of Dermatology. 15 April 2008.Link.

3. American Cancer Society. Cancer Facts & Figures 2009. Atlanta: American Cancer Society; 2009.

4. Lew RA, Sober AJ, Cook N, Marvell R, Fitzpatrick TB. Sun exposure habits in patients with cutaneous melanoma: a case study. J Dermatol Surg Oncol, 1983; 12:981-6.

5. Pfahlberg A, Kolmel KF, Gefeller O. Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation-induced melanoma. British Journal of Dermatology, March 2001; 144; 3:471.

6. Cress RD, Holly EA. Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of California cancer registry data, 1988-93.Cancer Causes Control 1997; 8:246-52.

7. "Sun Protection." National Cancer Institute's Cancer Trends Progress Report - 2007 Update. 15 April 2008. Link.

8. Godar DE, Urbach F, Gasparro FP, van der Leun JC. UV Doses of Young Adults.Photochemistry and Photobiology, 2003, 77(4): 453-457.

9. Christenson LJ, Borrowman TA, Vachon CM, Tollefson MM, Otley CC, Weaver AL, Roenigk RK. Incidence of basal cell and squamous cell carcinomas in a population younger than 40 years. JAMA. 2005;294:681-690.

10. "11th ROC: Ultraviolet Radiation Related Exposures." 27 January 2005. U.S. Department of Health & Human Services. 15 April 2008. Link.

11. The International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: Asystematic review.International Journal of Cancer 2006; 120:1116-1122.

12. Kwon HT, Mayer JA, Walker KK, Yu H, Lewis EC, Belch GE. Promotion of frequent tanning sessions by indoor tanning facilities: two studies. J Am Acad Dermatol 2003; 46:700-5.

13. Swerdlow AJ, Weinstock MA. Do tanning lamps cause melanoma? An epidemiologic assessment. J Am Acad Dermatol 1998; 38:89-98.

14. Bickers DR, Lim HW, Margolis D et al. The burden of skin diseases: 2004. J Am Acad Dermatol. 2006; 55: 490-500.

15. Demierre MF. Time for the national legislation of indoor tanning to protect minors.Arch Dermatol 2006; 139:520-4.

16. Taylor CR et al. "Photoaging/Photodamage and Photoprotection" J. of American Academy of Dermatology, 1990: 22

17. Ahmedin Jemal, Rebecca Siegel, Elizabeth Ward, Taylor Murray, Youngping Hao, Jiaquan Xu, and Michael J. Thun. Cancer Statistics, 2008. CA Cancer J Clin 2008 58: 76.

18. Cancer Epidemiology in Older Adolescents & Young Adults. SEER AYA Monograph Pages 53-63. 2007.

19. Melanoma of the Skin, Cancer Fact Sheets, National Cancer Institute, SEER Database, 2008. Link.

20. Karagas MR, Stannard VA, Mott LA, Slattery MJ, Spencer SK, and Weinstock MA. Use of Tanning Devices and Risk of Basal Cell and Squamous Cell Skin Cancers. J. Natl. Cancer Inst. 2002 94: 224; doi:10.1093/jnci/94.3.224

21. SEER Cancer Statistics Review, 1975-2004 (NCI) Link.

22. Spencer JM, Amonette RA. Indoor tanning: Risks, benefits, and future trends. J AM Acad Dermatol 1995; 33:288-98.

23. Lange JR., Palis BE, Chang DC, Soong S, Balch CM. Melanoma in Children and Teenagers: An Analysis of Patients From the National Cancer Data Base. J. Clin. Oncol.2007; 25:1363-8.

24. Ferrari A, Bono A, Baldi M, et al. Does Melanoma Behave Differently in Younger Children Than in Adults? A Retrospective Study of 33 Cases of Childhood Melanoma From a Single Institution. Pediatrics. 2005; 115:649-57.

25. Gloster HM, Neal K. Skin Cancer in Skin of Color. J Am Acad Dermatol 2006; 55:741-60.

26. Robinson JK. Sun Exposure, Sun Protection, and Vitamin D. JAMA 2005; 294: 1541-43.

27. Elwood JM, Jopson J. Melanoma and Sun Exposure: An Overview of Published Studies. Int J Cancer. 1997; 73: 198-203.

28. Strous JJ, Fears TR, Tucker MA, Wayne AS. Pediatric melanoma: risk factor and survival analysis of the surveillance, epidemiology and end results database. J Clin Oncol 2005; 23:4735-41.

29. "What is Squamous and Basal Cell Skin Cancer?" American Cancer Society. 5 May 2008. Link.

30. Armstrong, B.K., and A. Kricker, How much melanoma is caused by sun exposure?,Melanoma Research, 1993: 3:395-401.

31. "How Many People Get Melanoma Skin Cancer?" American Cancer Society. 13 May 2008. Link.

32. "The Burden of Skin Cancer." National Center for Chronic Disease Prevention and Health Promotion. 13 May 2008. Link.

33. Conti EM, Cercato MC, Gatta G, et al. Childhood Melanoma in Europe since 1978: a population-based survival study. Eur J Canc 2001; 37:780-4.

34. Huang CL, Halpern AC. Management of the patient with melanoma. In: Rigel DS, Friedman RJ, Dzubow LM, Reintgen DS, Bystryn J-C, Marks R, eds. Cancer of the Skin. New York, NY: Elsevier Saunders; 2005:265-75.

35. Perdue, Mark. Increase in melanoma cases among young American women. J Investigative Dermatology 2008.

36. Pleasance ED, Cheetham RK, Stephens PJ, et al. A comprehensive catalogue of somatic mutations from a human cancer genome. Nature 2009.

37. Howard W. Rogers, MD, PhD, Martin A. Weinstock, MD, PhD, et al. Incidence Estimate of Nonmelanoma Skin Cancer in the United States, 2006. Archives of Dermatology 2010.

38. Rogers, Howard. “Your new study of nonmelanoma skin cancers.” Email to Mark Teich. March 31, 2010.

39. Rogers, Howard. “Your new study of nonmelanoma skin cancers.” Email to Mark Teich. April 1, 2010.

These facts and statistics have been reviewed by

David Polsky, MD, Assistant Professor of Dermatology and Pathology, New York University Medical Center

and

Steven Q. Wang, MD, Director of Dermatologic Surgery and Dermatology, Memorial Sloan-Kettering Cancer Center, Basking Ridge, NJ.