The Truth about Men and Sunscreen

The Truth about Men and Sunscreen

Although the American Academy of Dermatology continues to launch costly prevention campaigns and has boosted public awareness for decades, an important question is posed: why does the incidence of skin cancers continue to soar? However, in this article, I want to focus on skin cancer trends in men.

Here are some alarming statistics: Caucasian men represent the demographic with the highest rate of annual UV exposure and highest rate of melanoma-specific deaths. The annual rate of new melanoma cases in men has nearly tripled in the past 30 years.

So, how could this be? We are living in a world where skin care lines routinely incorporate sunscreen preparations that are both elegant and affordable. Suncreen is seemingly ubiquitous in drug stores and supermarkets. The Skin Cancer Foundation and American Academy of Dermatology fuels millions of dollars into media- and web-based campaigns to educate the public at large.  So why does the prevalence of skin cancers continue to soar? Are these prevention campaigns working?

As a Mohs micrographic surgeon and skin cancer specialist, I consistently advocate regular sunscreen use and monthly self-checks to all of my patients, but especially in patients with a higher than average risk. Skin cancers in male patients demonstrate a more aggressive clinical course and are more likely to be fatal, when compared to women. Moreover, in a recent survey, only 51% of male patients reported sunscreen use, and 70% did not know the warning signs of skin cancers. This underscores that just being a man is a risk factor for skin cancer.

As a man, I realize my own weaknesses and limitations. The details and application recommendations for sunscreen use are voluminous and cumbersome to say the least. After reading the guidelines on the American Academy of Dermatology website, I was literally exhausted. Most men would read these guidelines and think, “When am I going to have time to play tennis ?” or “I came here to fish, not to apply sunscreen all day!”

It is true that most patients, especially men, are not thinking about skin cancer while enjoying their family vacation on the beach. However, we really should be. In my opinion this is central to the essence of the problem. We should be thinking about the fact that melanoma is much more deadly in our demographic, compared to women. We should be thinking that skin cancer and premature aging of the skin are entirely preventable. And most important, we should take ownership of our health. And while dermatologists are not asking patients to give up what they love—golfing, boating, surfing, sporting, fishing and fun on the beach—we are asking our patients to be responsible.

So here are some simple guidelines for men, so that we can continue to do the things that we love in the sun, while demonstrating responsibility and honoring our bodies.

• Rule # 1: You only get one life and one body, so protect yourself! Use sunscreen! Which sunscreen? Broad-spectrum, SPF > 30, and water resistant. My favorites are Germain Dermatology Super Sheer Spray and Blue Lizard for outdoor activities, since they offer the highest water resistance. SPF 30 blocks 97% of harmful UVB rays. Higher SPFs block only slightly more of the sun’s UV radiation. Broad spectrum refers to sunscreens that offer both UVA and UVB protection. UVA and UVB both cause cancer; however, UVA is responsible for premature aging of the skin.

Additionally, I recommend our sunscreens formulated by Dr. Marguerite Germain. The reason I recommend them so highly is that our patients LOVE them and use them regularly. Why? Because they are non-greasy, totally concealable, and contain naturally-occuring hypoallergenic and superpotent antioxidant ingredients, including green tea polyphenols, CoQ10 and resveratrol, which nourish your skin and provide additional anti-cancer activity. Over-the-counter sunscreens available at your local drug stores and markets may offer broad-spectrum photoprotection but contain toxic preservatives that can be damaging to your body. In my experience, the best way to promote routine skin care among my male patients is to deliver excellent products that make your skin feel and look its best.

Check out our top-of-the-line sunscreens at Germain Dermatology designed for our male patients:

Super Sheer: This ultra-sheer and non-greasy formulation contains 13.75% micronized zinc oxide, along with superpotent concentrations of green tea polyphenols and CoQ10 to provide the ultimate broad-spectrum and antioxidant protection in a cosmetically elegant preparation.

Super Sheer Spray (NEW): This is my favorite! I think it is perfect for male patients, because it is so easy to use for full-body applications on beach days.  Super sheer spray also contains superpotent zinc oxide for broad-spectrum sun protection in addition to high concentrations of antioxidants.

Blue Lizard: My favorite for long days on the beach. Blue Lizard offers great broad-spectrum coverage with the highest water resistance available. It is certified by Australian standards, which are manufactured at higher standards than American sunscreens.

Heliocare: An oral dietary supplement with antioxidant effects that promote the skin’s ability to protect itself against sun-related free radical damage.

• Rule # 2: How often to apply: Every two hours. I recommend using a buddy system if on the beach with friends. Share the responsibility and remind each other to reapply. Check your friends for red streaks and encourage more frequent application, should you see evidence of burning.

• Rule # 3: Avoid sun exposure between the hours of 10 am and 2 pm, during which time UV exposure is most intense.

• Rule # 4: ABSOLUTELY NO TANNING BEDS. Use fake tanners or bronzing agents instead! Everytime you think it might look great to have a tan, remember that by virtue of your being a man, you run a greater risk of developing skin cancer. MELANOMA IS DEADLY.

• Rule # 5: You feel your best, when you look your best. Protecting your skin from the sun will prevent photoaging (premature wrinkling of the skin), allowing you to look and feel your best! Here are products that are very popular among our male patients:

Magic Eyes: My personal favorite! It is so perfect for men, because we tend to develop deep wrinkles around our eyes over the years. Magic eyes is an elegant eye cream that contains high doses of Vitamin C and green tea polyphenols to prevent and reverse sun-induced wrinkling and aging of the skin.

Retinol Rejuvenation pads: Retinol is an advanced Vitamin A derivative that comes in several formulations that nourish your skin, improve skin tone and reduce fine lines and wrinkles. By increasing cell turnover, retinol also fights against harmful skin cancers! I recommend this highly for patients with a personal history of skin cancer.

Antioxidant cream: an elegant blend of our most bioactive antioxidants prepared in a hydrating serum. It is bioengineered to enhance skin texture and elasticity.

Advanced Vitamin C Serum: This is another favorite! Much more than pure Vitamin C, it is our most concentrated blend of antioxidants, containing L-ascorbic acid, Vitamins A and E, emblica and ubiquinone. This serum is lightweight, hydrating and full of goodness! A perfect fit for our male patients!

• Rule # 6: Know the skin you’re in. YOU ARE RESPONSIBLE for your own health. Own this. Do monthly self skin-checks and alert your dermatologist if you notice any new or changing dark spots or red spots. Use the mnemonic ABCDE to identify suspicious lesions. Alert your skin cancer provider should you find dark spots with any of the following:

A: Asymmetry

B. Border irregularity

C. Color variegation

D. Diameter > 6 mm (roughly the head of a pencil eraser)

E. Elevation

• Rule #7: Get skin exams yearly with your dermatologist. If you have a history or family history of skin cancer, you need skin exams twice yearly.

Dr. Joe’s tips for supreme #sunsafety:

1️⃣ wear sunscreen everyday and reapply every hour

2️⃣ avoid peak UV exposure from 11 am to 4 pm

3️⃣ wear a sunscreen (spf 30 or higher) that contains a physical blocker like Zinc and protects against UVA and UVB

4️⃣ take heliocare

5️⃣ wear a UV protective broad-brimmed hat and UV protective clothing

6️⃣ if you have a new or changing skin lesion, one that bleeds, or is painful, please see a board-certified dermatologist ASAP for biopsy! Don’t wait until it’s too late !!

7️⃣ if you have a personal or family history of skin cancer, Head to toe skin exams are needed every six months! If you have a personal history of melanoma, skin exams every 3 months x 2 years; then q6 months.

It’s ok to have fun in the sun! Just do it safely! #sunsafety #drjoe

Dr Joe getting his #sunsafety on!

Melanoma (Part III) - Skin Cancer Awareness Month

Part III: Fun in the Sun / Nonmelanoma Skin Cancer

As I’m sipping my coffee on the oceanfront porch of our beachhouse rental while on family vacation, I think to myself, am I a total hypocrite? I am a dermatologist and dermatologic surgeon specializing in Mohs micrographic surgery in Charleston, South Carolina, one of the most touristed, beach-friendly, vacation-centric places in the Southeast. Every week I am inundated with patients young and old who are interested in taking care of their skin, preventing skin disease, skin cancer and optimizing their solar protection. However, while on vacation, I’m blown away by all of the vacationers who literally fry themselves to all shades of pink and red.

I think that a key part of helping my patients and intervening in a meaningful way is recognizing that the same people who are so interested in protecting their skin, are in fact, going to participate in the same cultural norms established over decades: fun in the sun. Whether it be fishing, boating, golfing, hiking, tennis, beach going, kayaking, kiteboarding, etc., human beings love being active and enjoying the great outdoors. 

So while I’m sipping my coffee in the early morning sun, taking my heliocare and applying my second coat of sunscreen before 8 am, I notice partner is looking at me, rolling his eyes, as if I am slightly ridiculous. He lovingly jokes about my predictable type A, OCD, “wound up tighter than a tic” behavior and I smile. However I also realize that we have the power to rise above the hypocrisy. “Fun in the sun” doesn’t have to be mutually exclusive. All we have to do is honor our bodies and commit ourselves to photoprotection:

1. Avoid peak sun hours

2. Seek shade when possible

3. Wear UV protective clothing

4. Wear a waterproof SPF 30 or higher sunscreen; apply regularly, every hour to two hours without exception

5. Take a B vitamin containing nicotinamide - known to prevent skin cancer

6. Take Heliocare - a natural, antioxidant complex that raises the threshold above which sun damage occurs

7. Get a skin exam every year with a dermatologist; if you have had a skin cancer, you’ll need to go every 4-6 months

Part three of skin cancer awareness month focuses on nonmelanoma skin cancer (NMSC). The type of surgery that I perform daily, Mohs micrographic surgery, deals with the surgical treatment of two types of skin cancers caused primarily by sun exposure: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

Fortunately, these types of skin cancers are much more common than melanoma and much less severe, generally speaking. However if left untreated, these relatively indolent skin cancers can develop aggressive features and spread to lymph nodes and other organ systems. Therefore, it is essential to recognize and diagnose these cancers early in their evolution. 

With some subtle differences and exceptions, NMSCs arise as pink or red, slightly rough/scaly, ulcerated/eroded, or waxy/translucent plaques on the skin. Many times patient will present with a “pimple that won’t go away”. These pesky facial lesions, often difficult to diagnose, especially in patients with rosacea or acne vulgaris, share a common feature: inflammatory lesions will resolve on their own; however, cancers will not. A general rule of thumb for me as a diagnostician, is that if a bump last longer than two weeks, a biopsy should be performed to exclude other pathology. 

I am reminded how THOROUGH skin exams are so vital: basal cell carcinoma’s seem to hide themselves underneath full heads of hair, within axillary and inguinal creases and on the derrière. Certain types of squamous cell carcinoma have a predilection for genital skin and are often linked to the same human papilloma virus strains that can cause cervical and anal cancers. 

Certain populations (i.e., Hispanic patients) grow basal cell carcinomas that express pigment, often causing concern for melanoma. However, by and large, Caucasians are most vulnerable to the damaging and carcinogenic effects of the sun, with rates continuing to rise.

Many of my patients are immunosuppressed, whether it be due to certain forms of leaukemias or lymphomas, the immunosuppressive effects of chemotherapies, or concurrent antirejection medicines in organ transplant patients. If you have leukemia or lymphoma, or on chemotherapy or antirejection medicines, please see a dermatologist every six months for a skin exam. This group of patients is very vulnerable to high-risk, aggressive SCC, especially on sun-exposed skin. SCCs that arise need to be diagnosed and treated ASAP, to avoid spreading. 

Recent data show a dramatic increase in skin cancer incidence: A study in the Archives of Dermatology reveals that approximately two million people in the US develop over 3.5 million nonmelanoma skin cancers every year. This constitutes more than a 300 percent increase in skin cancer incidence since 1994. These new numbers are alarming but not completely surprising, as there has been a gradual and predictable rise in the rates of both nonmelanoma and melanoma skin cancers in the past several decades. In 1994, a report in the Journal of the American Academy of Dermatology estimated total US incidence of BCC and SCC at approximately one million cases per year. Since 1994, skin cancer procedures in several databases have jumped by 76.9 percent.

Dr. Brett Coldiron, at the forefront of dermatologic surgical research and leader in the American College of Mohs Surgery, thinks the dramatic rise can be attributed to several factors: it’s calculated the the number of skin cancers in 1994 was underestimated and probably closer to 1.5 million. In addition, it is suspected that the increase is due to sun exposurel, and, shockingly, a continued increase in the use of tanning parlors. Additionaly, the baby boomer generation is aging, and most skin cancer patients are over 65.

Check out these FAQs from the Skin Cancer Foundation:

NONMELANOMA SKIN CANCER

• The diagnosis and treatment of nonmelanoma skin cancers in the U.S. increased by 77 percent between 1994 and 2014.6

• About 90 percent of nonmelanoma skin cancers are associated with exposure to ultraviolet (UV) radiation from the sun.

• Basal cell carcinoma (BCC) is the most common form of skin cancer. An estimated 4.3 million cases of BCC are diagnosed in the U.S. each year, resulting in more than 3,000 deaths.

• Squamous cell carcinoma (SCC) is the second most common form of skin cancer. More than 1 million cases of SCC are diagnosed in the U.S. each year, resulting in more than 15,000 deaths

• Organ transplant patients are approximately 100 times more likely than the general public to develop squamous cell carcinoma

• Regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing squamous cell carcinoma by about 40 percent

In conclusion, remember that YOU have the power to prevent skin cancer! We can still have fun in the sun, we just have to be smart. After reading this series of blog posts during Skin Cancer Awareness month, I hope to have helped patients understand the progression of skin cancers and sun-related precancerous damage, introduced methods of skin cancer prevention and empowered patients to have healthy, youthful, radiant, cancer-free skin. Remember to see your dermatologist regularly, wear sunscreen and know what to look out for. Skin cancer is entirely preventable so stay healthy, have fun and be safe everybody!

Melanoma (Part II) - Skin Cancer Awareness Month

Just to reinforce how everyone needs a skin exam, I wanted to reference an article I wrote which highlights certain features of melanomas diagnosed in African-American patients. It is a dangerous misconception that darker skin tones are not at risk for skin cancer. Although the incidence of skin cancers in darker races is lower than Caucasian patients, skin cancer can happen in ANYONE. Remember that Jamaican singer-songwriter Bob Marley died of melanoma at age 36. 

A recent study in the Journal of the American Academy of Dermatology, showed that melanoma diagnoses in people of color were more likely to be more aggressive, and diagnosed in the later stages of evolution, associated with a poor prognosis and lower survival rate. It is therefore of paramount importance to educate all people about skin cancer, including African-American patients who are susceptible to a specific type of very aggressive melanoma. The subtype of melanoma more prevalent in darker skin tones, including African-American and Hispanic patients, is called Acral Lentiginous Melanoma which occurs on the palms of the hands and the soles of the feet. The development of these skin cancers on acral sites suggest causative factors, including genetics or environmental influences, other than ultraviolet radiation. However, UV radiation is still very dangerous and linked to the development of skin cancers in patients of all skin types. A recent study showed that 63% of African-American participants said that they had never used sunscreen. It is important to realize that race or ethnicity does not define skin type, and sunscreen use is important for all skin types.

If you are interested in learning more about this subject, click the link below to read an in-depth case study I wrote with Angela C. S. Hutcheson, MD, John C. Maize Jr., MD, and Jeol Cook, MD, on Multiple Primary Acral Melanomas in African-Americans.

Melanoma (Part I) - Skin Cancer Awareness Month

Every year I am astounded that my skin cancer patients keep getting younger and younger... And I’m not talking about those patients in their 40s and 50s, I’m talking about patients in their 20s and 30s. Yes, we are all at risk for skin cancer. Whether it be due to a genetic predisposition or excessive exposure to the sun‘s harmful ultraviolet radiation, skin cancer can happen to anyone. 

As the incidence of melanoma and nonmelanoma skin cancers continue to rise, I am reminded of the importance of patient education, raising public awareness of what to look for on self-screening exams, increasing the accessibility of sunscreens and making sure all people know that it is important for everyone to see a dermatologist regardless of their personal or family history.

I find that while patients might realize their sensitivity to sunlight may be extreme or even moderate even in their youth, understanding that tanning is actually a form of injury to the skin, which can set up fertile soil for skin cancer growth is not something that resonates. That's why I want to raise awareness though this blog, especially during the month of May, so that my friends, family, patients and even complete strangers might understand that taking care of their skin now can prevent serious sun-related injury and deadly skin cancers. 

It is empowering as a Mohs micrographic surgeon, to realize that skin cancer is both a very treatable and a very preventable disease. While many cancers grow very slowly, certain cancers including aggressive squamous cell carcinomas and melanoma, can grow quickly and require diagnostic and surgical intervention as soon as possible. While I see nonmelanoma skin cancer in young patients, it is important to realize that the most deadly skin cancer, melanoma, has a higher rate of occurrence in younger patients. Melanoma represents the highest skin cancer-related mortality in patients in their 20s and 30s.

In this first segment, I am going to focus on melanoma, a deadly form of skin cancer that can occur in anyone, any race, any part of the body....even in the eyes. Melanocytes, or pigment-producing cells of the body, when exposed to harmful UV rays, can be damaged through photo-injury which can cause melanoma growth. Melanomas grow first in an early radial growth phase, during which diagnosis is crucial. When melanomas are excised through surgical excision, margins must be large to ensure complete eradication of all atypical cells. The later (vertical) growth phase can often times be too late: this is when roots grow more deeply and distant spread to other organ systems can occur. Surgery is still the mainstay of melanoma treatment but other adjuvant therapies may be required in advanced cases.

[1]

In my practice, I am seeing more and more melanoma in younger patients. It is frightening to think that these aggressive cancers can develop rapidly in healthy, young, vibrant people, but it happens! So read this blog to find out how to keep yourself safe and cancer-free!

What is melanoma and what is the incidence of melanoma?
Melanoma is the most serious form of skin cancer and is characterized by the uncontrolled growth of the pigment-producing cells of the skin. Melanomas can grow primarily but also can develop within an existing mole. The overall incidence of melanoma continues to rise and, surprisingly, melanoma rates in the United States doubled from 1982 to 2011. Age-specific indices of melanoma case seem to be growing drastically as well. Male sex seems to impart an increased risk: interestingly rates of melanoma diagnoses in men are rising sharply. [2]

Is melanoma a serious disease?
YES!!! Although completely treatable when detected early, advanced melanoma can spread to the lymph nodes and internal organs, which can be fatal. Approximately 9,320 people will die from melanoma in 2018. [2]

What causes melanoma?
Risk factors for developing melanoma includes the following:

• Ultraviolet light exposure from the sun is linked to 95% of melanoma cases [2]
• Tanning Bed use/exposure; especially in women < 45 [2]
• Living close to the equator. [2]
• Age > 65 - suggestive of cumulative effect of harmful UV rays. [2]
• A history of 5 or more blistering sunburns between ages 15 and 20 increases one's melanoma risk by 80 percent. [2]
• Lighter skin tones and Caucasian race [2]
• history more than 50 moles, unusual moles or large moles on the skin. [2]
• family history of melanoma or personal history of nonmelanoma skin cancer, including squamous cell carcinoma or basal cell carcinoma [2]
• Physical characteristics: history of sun sensitivity, red/blond hair, blue or green eyes [2]

[3]

Does Melanoma have a precancer lesion?
The answer is Yes! Atypical moles are the precursor lesion to a melanoma, although some melanomas arise primarily as full-blown cancer. Suspicious signs of an atypical moles would be larger size, color variability and border irregularity. Some patients have 100s of atypical moles, making them at increased risk for melanoma. [2]

What does melanoma look like?

Use the following ABCDEs of melanoma as a guide for recognizing pigmented lesions that are atypical and require biopsy in some instances.

• Asymmetry: if one half does not match the other half. [2]
• Border irregularity: If the edges are jagged, notched or blurred. [2]
• Color: A lack of uniformity of color, color variability or color variegation. If different shades of tan, brown or black are often present. If spots of red, white, and blue are present, this also suggests atypia. [2]
• Diameter: Larger lesions, greater than 6mm are at increased risk for Melanoma, but melanomas can also be quite small (<1 mm) [2]
• Evolving: if a mole looks different than the rest or demonstrates change over time, including color change, growth, border change. [2]

So stay safe everybody! Here are some tips to protect yourself:

• Everyone needs a skin exam. If you have a mole, a new growth, or one that is changing, it is essential to get this diagnosed and evaluated by a trained professional. Dermatologists need to be the ones that evaluate these suspicious lesions, not general doctors. Dermatologists are specialists that are trained to diagnose and treat skin cancers, precancers and other skin lesions correctly.
• People with a family history of skin cancer, especially melanoma, are at higher risk for melanoma and therefore definitely need routine skin exams yearly.
• People who do not have a family history of skin cancer are still at risk for skin cancers. These physical characteristics are high predictors of increased susceptibility: red or blonde hair, blue eyes, freckling, or lighter skin tones.
• Tanning = solar damage. Tanning is a physical indication that you are not putting on enough sunscreen and/or getting too much sun. While less damaging than a sunburn, tanning represents increased dispersion of melanin with in the epidermal cells called keratinocytes. This is an indication of damage to DNA that is occurring within your epidermal cells. So take tanning as a warning sign: apply more sunscreen, apply more frequently, use better sunscreens and avoid sun exposure.
• Tanning beds are the enemy. These dermatologic nemeses are basically superdoses of concentrated ultraviolet radiation. You are basically frying your skin when you go to the tanning bed. A history of tanning bed use is strongly associated with early-onset melanoma. So PLEASE avoid the tanning beds at all cost!
• If you notice a new mole, a mole different from others on your skin, or one that changes, itches or bleeds, even if it is smaller than 6mm, you should make an appointment to see a board-certified dermatologist as soon as possible

References:

1. American Association of Cancer Research. Clinical Cancer Research. Well-Defined Melanoma Antigens as Progression Markers for Melanoma: Insights into Differential Expression and Host Response Based on Stage; Fig. F. Stephen Hodi; DOI: 10.1158/1078-0432.CCR-05-2616. Published February 2006. http://clincancerres.aacrjournals.org/content/12/3/673.figures-only

2. American Academy of Dermatology. Melanoma; 2018. https://www.aad.org/media/stats/conditions

3. MedIndia. Melanoma. Melanoma; What are the Risk Factors for Melanoma? Published on Jul 25, 2011. https://www.medindia.net/patients/patientinfo/melanoma.htm

4. Mayo Foundation for Medical Education and Research. Melanoma; Overview. https://www.mayoclinic.org/diseases-conditions/melanoma/symptoms-causes/syc-20374884

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Anti-Inflammatory Diet = Bright Youthful Skin

It continues to amaze me how staying healthy, active and staying away from dietary sugars, dairy and gluten can make our skin look bright, fresh and youthful. In addition to psoriasis, an inflammatory skin condition with an obvious link to metabolic, genetic and environmental factors, acne and eczema outbreaks can be reduced or minimized by altering the diet. Inflammation seems to be at the core of so many diseases, including cardiovascular disease, migraines and Alzheimer's disease. The good news is we all have the power to modulate this inflammatory cascade not through medicines, but by staying active, engaging in cardiovascular exercise and adhering to an anti-inflammatory diet. 

In the past, I have had the pleasure of consulting a true expert, Dr. Will Bulsiewisz about the concept of dysbiosis, which essentially is the lack or imbalance of beneficial gut bacteria. Who would think that bacteria could actually be so important? Well they are SUPER important: We have more bacteria in our gut than we do cells in our body! There are approximately 400 subspecies of bacteria in our gastrointestinal system that constitute our gut microbiome. These essential bacteria allow us to digest food, process vitamins and defend us from harmful pathogenic bacteria. The "good guys" (healthy bacterial colonies) so to speak are vital to prevent the overpopulation of the "bad guys" (harmful bacterial colonies). If the "bad guys" start to outnumber the good, then dysbiosis results. In this situation, yeast, and harmful bacteria can change the way we process food, causing chronic digestive conditions, such as leaky gut syndrome, irritable bowel syndrome, Crohn's disease, Ulcerative Colitis and (small intestinal bacterial overgrowth syndrome) SIBO.

Internationally renowned dermatologist Dr. Whitney Bowe has written an eye-opening book, "The Beauty of Dirty Skin" that addresses how the gut microbiome is central and fundamental to the treatment of rosacea, acne, eczema, premature aging and psoriasis. Interestingly, her book addresses how lasers, topical creams and pharmaceuticals will not consistently guarantee the glowing skin that we all want. Instead we should focus on our microbiome--altering our diet to enhance a healthy bacterial flora in our gut. 

Let's thank Dr. Bowe for her brilliant insights on the microbiome and the connection between sleep, stress, diet, gastrointestinal health, and the health of your skin. 

Tips for living a healthy lifestyle and having radiant skin:

1. Exercise - get into a regimen of just three 30 minute weekly routines that focus on cardiovascular fitness. Getting your heart rate up will burn calories and fat, reducing systemic inflammation and lower harmful pro-inflammatory cytokines that cause stress and disease if elevated chronically.
2. Reduce or eliminate sugar - Perhaps the biggest culprit in propagating systemic inflammatory disease, cancer and dysmetabolic syndrome (hyperlipidemia and diabetes type 2)
3. Avoid taking antibiotics unless medically necessary. Antibiotics facilitate fertile soil for harmful, drug-resistant pathogenic bacterial strains that can overwhelm our healthy microbiome and wreak havoc. These resistant strains can grow quickly and change the way we process and metabolize food and nutrients. This theory explains how sufferers of irritable bowel syndrome, inflammatory bowel disease and SIBO may experience flares during periods of dietary provocation. 
4. Take a probiotic: I love Metagenix, VSL, Garden of Life (which can be purchased at Whole Foods) or our skinny probiotics at Germain Dermatology.
5. Reduce or eliminate dairy, soy, gluten and animal fat: Four triggers that can contribute to acne breakouts, inflammatory skin conditions and inflammatory systemic disease.
6. Start meditating: Whether it be yoga, silent meditation or other stress reduction technique, controlling and quieting our thoughts can be so therapeutic in reducing anxiety and depression without pharmaceutical intervention. Stress is linked to inflammation, so if we can find a healthy way of diffusing stress, then we are actually preventing certain inflammatory diseases, and more importantly, living the healthiest life possible.

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