Dr. Mercurio

Can you tell us a little bit about gender implications in the field of dermatology?

Gender differences in dermatology are becoming increasingly more apparent. For example, compared to men, women have a much higher incidence of autoimmune diseases, different responses to hormonal stimuli and a different distribution over the body of some skin cancers. It is important that more research be done in this area, using gender as a variable.

What affect do hormones have on skin? Is skin always affected?

Hormones have a significant impact on the skin. Puberty, pregnancy and menopause all have a unique impact on the skin. As we all know, many adolescents are prone to acne. Some women get melasma or coffee-colored stains on their face during pregnancy that may or may not go away. Menopausal women often have skin atrophy resulting in fragility, fine wrinkling and slower wound healing.

What about hormone replacement therapy and birth control pills? How do they affect women’s skin?

Some women have an increased sensitivity to male hormones that causes acne, excessive body hair, and loss of the female distribution of hair on the body. For these women, oral contraceptives are quite helpful. Furthermore, there is increasing evidence that for the postmenopausal woman, hormone replacement therapy counteracts the biological processes that result in skin fragility, dryness and fine wrinkling.

Are there different kinds of acne? If so, does treatment differ as well? What preventive measures can be taken?

Many factors are involved in the development of acne. In all acne patients, there are many factors involved with the origination and development of the condition. In adult women with acne, the key is increased sensitivity to male hormones. Because of this, these patients benefit very little from traditional teenage acne treatments–but respond very well to hormonal interventions.

Getting this information out to adult women with acne is critical because it can impact self-esteem and make social interactions more difficult. The wrong kind of treatment can prolong the condition–as well as the patient’s embarrassment and discomfort–unnecessarily.

What role does the skin play in diagnosing disease? Does our skin tell us when something is wrong internally?

One of the most gratifying aspects of dermatology is the fact that we can diagnose a whole host of diseases by simply identifying their unique and telltale signatures on the skin. For example, dermatologists can discover a number of illnesses–diabetes, thyroid disease, ovarian cysts, certain types of cancers and collagen vascular diseases–through recognition of characteristic skin lesions often precluding the need for invasive diagnostic procedures.

Medications can often affect the skin adversely. Why is this the case? What should a patient do?

Allergic reactions to medications are frequently evident in the skin. This is because of the skin's rich supply of immune-competent cells. Luckily, most allergic reactions are more nuisance than anything else–frequently limited to a harmless itchy rash. Certain drug-induced rashes can, however, be life threatening, particularly those that produce skin pain or blisters. Patients should immediately notify their physician if they develop any skin rashes while taking a prescribed medication.

Recently, there has been an increase in public awareness of skin cancer and the danger of sun exposure. What advice do you give patients about appropriate protection?

Sun exposure is the most preventable, controllable risk factor for skin cancer. I advise my patients to follow a comprehensive regimen of sun protection that includes avoiding midday sun and artificial tanning devices, wearing protective clothing, and using sun block daily.

Some of my younger female patients are more tuned into the importance of sun protection, because of the now well-known correlation between sun exposure and premature wrinkles. I also stress to women the importance of instilling healthy sun protection habits in their children. Most sun damage occurs before the age of eighteen. The skin has a memory upon which further damage builds.

Should patients have regular check-ups with a dermatologist? What should they expect/look for in a thorough exam?

In this era of managed care with limited access to specialists, it is increasingly more difficult for patients to see a dermatologist. I advise patients to take personal responsibility for their skin health. This requires the comprehensive approach I described earlier, as well as skin self-examination so that an individual can identify changing moles or new growths early.

Melanoma, the most serious form of skin cancer, has a tendency to arise on areas of skin that are not regularly exposed to the sun–underscoring the importance of head-to-toe skin examinations. A check up with a dermatologist should cover every area of the body, including the scalp, inside the ears, between the toes, etc. A patient who has previously been diagnosed with skin cancer–or has risk factors for the development of skin cancer, such as a family history of the disease–warrants regular evaluation by a dermatologist.

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