Keeping it Real with Dr. Eric Bernstein

Q: Welcome to keeping it Real, Dr. Bernstein! We know you’re a dermatologist. Tell us, what kind of patients do you see?

A: I am a board-certified dermatologist, but my practice is limited strictly to treating patients with lasers for a variety of skin conditions. I use a number of vascular lasers to treat spider veins of the face and legs, scars, port-wine stain birthmarks, rosacea and sometimes warts. I use another type of lasers to treat brown spots such as freckles \[and\] for removing unwanted tattoos. I also do laser hair removal and laser wrinkle reduction. The majority of the patients I see are women. However, men do make up a significant portion of my practice.

Q: What can you tell us about the skin and its role in health and fitness?

A: Being a dermatologist, of course I think the skin is the most important organ in the body. It is certainly the largest organ and protects us from the outside world. Because it protects us from the outside world, the skin is susceptible to all the insults that come at us from the environment. These include, during the winter months, dryness in the environment which causes a host of problems for our skin. The sun puts out ultraviolet radiation, which as you have seen in your house or car can fade leather or fabrics. ... Sun damage is the largest cumulative insult on our skin. Having intact skin barrier is critical for us to remain fit. If any of you have had a skin problem, you know the effect that it has on our whole being. It is virtually impossible to work out when you are having pain or irritation from an area of your skin.

Q: How does healthy skin look and feel?

A: Healthy skin feels soft, supple and not scaly. It should be relatively even in appearance. The best example of super healthy skin would be that of a baby. It is so full of these chemicals in our skin called GAGs, that is gives the appearance of bursting because it is so full of water. It is these GAGs that allow our skin to maintain water so that our cells can move freely within it to repair any problems.

Q: What tips can you give for maintaining healthy skin?

A: The biggest tip I can give for maintaining healthy skin is to use protection from the sun. The sun is the single biggest assault on our skin. It causes fine lines, wrinkles, brown spots, skin cancers, unwanted veins, enlarged pores, skin sagging [and also] suppresses the skins’ immune system. In fact, sunlight hitting the skin can affect the whole body’s immune system in a negative way. So, my biggest advice for people is to use sunscreen every day. I recommend sunscreens with high SPFs. Physical blockers such as zinc- and titanium-containing products or those products containing Parsol 1789 have a significant amount of UVA blocking ability. The other tip I can give for maintaining healthy skin during the wintertime is to make sure to use plenty of moisturizers. I tell patients to use a moisturizer in the shower while they are wet BEFORE they towel off. Over the counter moisturizers are just fine for this purpose. Baby oil (preferably the unscented type) is also easy to apply immediately after a shower. I also use a lot of Aquaphor, a moisturizer with the consistency of petroleum jelly. Aquaphor is like the dermatologists’ duct tape in my opinion. It often helps to improve a number of skin conditions, including minor cuts and abrasions.

Q: Does the advice apply to everyone? Or does the plan for healthy skin vary based on skin type?

A: Advice for healthy skin does apply to everyone. However, a plan needs to be adjusted based on a person’s skin type. For example, someone with oily skin probably would have a hard time using a moisturizer on his or her face. So, advice does need to be adjusted to an individual.

Q: What role does diet play in healthy skin?

A: There are very few studies demonstrating an effect of diet on maintaining healthy skin or diet having a major effect on skin diseases. Having stated that ... I think eating a healthy, well balanced, diet is good for the body as well as the skin.

Q: Is it common for people to develop skin problems as a result of exposure to the heat or cold during a particular sport?

A: People spending a great deal of time outside during the cold months often get dry, cracked skin. This is because cold air holds very little moisture. Thus, if the air lacks moisture, the skin will lose moisture to the air and become dry. Of course excessive exposure to the cold can result in frostbite, and immersion of the feet in cold water for prolonged periods of time can result in skin problems. Performing sports outside during the summer months often leads to acne and acne-like bumps called miliaria during the summer months. In addition, during the hot summer months, people can develop fungal infections of the skin such as tinea versilcolor. Tinea versicolor most commonly shows up as white or dark spots on the chest and back. This is due to a fungus that normally lives on our skin, but tends to spread when we get into the hot weather and our skin oils are more pronounced. This fungus loves to live in the oily areas of our skin. In fact, it’s grown with oil in the laboratory. In addition, other fungal infections such as athlete’s foot or jock itch are often seen in the summer months.

Q: What advice can you share on ways to avoid and or treat common skin problems?

A: In the wintertime, it is important to moisturize while wet, before coming out of the shower. Common advice from dermatologists is also not to take showers that are too hot. Using a mild soap in the wintertime can also help. I like NeoStrata’s bath and body gel, which contains gluconalactone, a mild poly-hydroxy acid, or Oil of Olay bar soap (unscented). In the hot summer months, it is important to dry thoroughly after taking a shower, and not remain in clothes that are wet. I also firmly believe if people have a skin problem, it can save time and money to go to your local dermatologist to get advice on how to deal with these problems.

Q: Should picking up infections at the gym through the skin be a major concern for people? If so, what are some measures people can take to protect themselves?

A: I have seen patients who have caught herpes simplex infections and athletes foot from a gym environment. One thing people can do at the gym is wear flip-flops or sandals in the shower. Athletes foot as well as warts can be acquired from a shower or swimming pool floor where a number of people walk. Warts are simply a virus that affects the surface layer of the skin, known as the epidermis. These are passed from person to person. Wearing flip flops or water shoes, putting towels down on benches or mats, and wiping down a mat surface when practical are simple measures one can take to help avoid these problems

Q: What about women who lose weight then find their skin is sagging? What should they do? Are there any procedures to eliminate or minimize this?

A: What to do with sagging skin after loosing weight is a good type of a problem to have. Time will not heal all, but skin can often partially bounce back to shape after a period of rapid weight loss. After time has had its chance, a visit to a plastic surgeon may be necessary for people to get the result they desire. A "tummy tuck" is such a procedure.

Q: While not a fitness matter, I can't let you get away without asking about wrinkles. What - outside of Botox or surgery - can women do to reduce or get rid of them?

A: Wrinkles predominately occur from the sun. Most people attribute an aged appearance to the passing of time. But if you compare the skin on your face to skin on other areas on your body, you will see that there are not wrinkles on the other areas of your body, only on the sun-exposed sites. When people loose muscle mass or weight, such as is commonly seen on people’s bottoms with aging, the skin will sag; but if you look closely, you will see that there are not wrinkles on that sagged skin. Botox works wonders for lines caused by the muscles of facial expression. These are the lines on the forehead as well as the lines on the ‘smile lines’ seen on the side of the eyes. To improve wrinkles elsewhere on the face, there are a number of topical and laser treatments. The most serious laser treatment is laser resurfacing, which removes the surface layer of the skin and requires a significant time for healing. Recently, lasers that rejuvenate the skin without producing a wound have become extremely popular. These lasers produce more subtle and gradual improvement, and require a number of treatments for results. I cannot over-emphasize the positive effects one can get from using simple topical treatments. A sunscreen is a must. It makes no sense to treat wrinkles without preventing their further reoccurrence. In addition to using a sunscreen, alpha-hydroxy acids, retinoids (Retin-A type products) and a variety of other agents too numerous to mention have been used to rejuvenate and improve sun damaged skin.

Q: Can you suggest any Web sites or other resources that may be useful to women who are looking for information, good dermatologists and products?

A: My favorite Web sites for getting dermatologic advice are the American Academy of Dermatology Web site, the American Society for Dermatologic Surgery Web site and the American Society for Laser Medicine and Surgery Web site.