Dermatology of the Aging Skin - AAP.org · PDF fileon aging skin some people try to turn back...
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Transcript of Dermatology of the Aging Skin - AAP.org · PDF fileon aging skin some people try to turn back...
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Dermatology of the Aging Skin
William R. Crain, MD, FAAD, Associate Clinical Professor of Dermatology, University of California, San Francisco
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I HAVE NOTHING TO DISCLOSE.
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My eagerness to give this talk
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ON AGING SKIN
SOME PEOPLE TRY TO TURN BACK THEIR ODOMETERS…
NOT ME!
I WANT PEOPLE TO KNOW WHY I LOOK THIS WAY. I’VE TRAVELED A LONG WAY, AND SOME OF THE ROADS WEREN’T PAVED.
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SKIN CANCER
5 MILLION NEW CASES /YEAR
$8.1 BILLION COST of CARE
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MELANOMA
> 76,100 NEW CASES/YEAR
9710 DEATHS/YEAR
One of commonest cancers in young adults (National Cancer Institute)
LIFETIME RISK:
Whites: 2%
Blacks: 0.1%
Hispanics: 0.5%
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MELANOMA?
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Keratoses
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Keratosis
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Lentigo Maligna Melanoma
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Nodular Melanoma
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Superficial Spreading Melanoma
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Superficial Spreading Melanoma
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MELANOMA
A- ASYMMETRY
B- IRREGULAR BORDERS
C- COLORS: BLACK, BLUE, RED
D- DIAMETER EQUAL OR > PENCIL ERASER
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COMPLETE SKIN EXAM
PERSONAL/FAMILY HISTORY
>50 Y.O.
FAIR COMPLEXION
NUMEROUS NEVI
ATYPICAL NEVI
HISTORY OF TANNING BED USE
HISTORY OF BLISTERING SUN BURNS
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TOTAL BODY!
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Self-Exam
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Measurement
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Measurement
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Skin Self-Exam
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Excisional Biopsy
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MELANOMA PATH REPORT
TUMOR THICKNESS
ULCERATION
MITOTIC RATE
HOST RESPONSE
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Depth of Invasion
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Sentinel Node Exam
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MELANOMA Chemotherapy
Interferon
Vaccines
BRAF
Monoclonal Antibodies
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Basal Cell Carcinoma
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Basal Cell Carcinoma
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Basal Cell Carcinoma
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BASAL CELL CARCINOMATREATMENT OPTIONS
EXCISION
C&D
DEEP CRYOSURGERY
RADIATION
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Dr Frederick Mohs
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RISK FACTORS FOR BASAL CELL EPITHELIOMA
CHRONIC SUN EXPOSURE
RADIATION EXPOSURE
FAIR SKIN
GENDER (MALES>FEMALES)
AGE >50
PERSONAL/FAMILY HX
IMMUNE SUPPRESSION
ARSENIC EXPOSURE
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Squamous Cell
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RISK FACTORS FOR METASTASIS
TUMOR DIAMETER > 2cm
INVASION INTO FAT
PERINEURAL INVASION
POOR HISTOLOGIC DIFFERENTIATION
LOCATIONON EAR, TEMPLE, ANOGENITAL AREA
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ACTINIC KERATOSIS TREATMENT
LIQUID NITROGEN FREEZING
5 FLUOROURACIL CREAM
IMIQUIMOD CREAM
INGENOL MEBUTATE GEL
DICLOFENAC GEL
PHOTODYNAMIC THERAPY
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Local Cryo Therapy
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Field Therapy of AK’s
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SUN PROTECTION
SUN AVOIDANCE
CLOTHING
SUN SCREEN
NO TANNING BED!
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Sun Protective Clothing
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SUN SCREENS
BROAD SPECTRUM: “CRITICAL WAVELENGTH TEST”
SPF 30 or HIGHER
WATER RESISTANCE 40/80
“ONE OUNCE, ONE BODY, ONE TIME”
REAPPLY
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Critical Wavelength Test
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Sunscreens
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Spray Sunscreen
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ANTI-TANNING BED PROGRESS
FACTS v. MYTHS
LEGISLATIVE ACTION
MEDICAL GROUP ACTION
FTC Action
FDA Action
ACA Tax
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TANNING BED FACTOIDS
44 STATES + D.C. HAVE REGULATIONS
11 STATES BAN USE FOR < 18 Y.O.
BLACK BOX WARNING UPGRADE BY FDA MAY 2014
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CAUSES OF ITCHING
XEROSIS
DRUGS
DIABETES
DISEASE
INFESTATIONS
NEUROLOGICAL
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Dry Skin
Aging Skin
Irritants
Environment
Drugs
Diseases
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Dry Skin Eczema
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Dry Lake
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Favored Moisturizers
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ROSACEA
ERYTHEMATOTELANGIECTATIC
PAPULOPUSTULAR
PHYMATOUS
OCULAR
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Rosacea
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Rosacea
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Rosacea
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OCULAR ROSACEA
BLEPHARITIS
CONJUNCTIVITIS
PHOTOPHOBIA
FOREIGN BODY SENSATION
CYSTS
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ROSACEA STIMULI
STRESS
HOT DRINKS
ETOH
SPICY FOODS
EXERCISE
COLD OR HOT WEATHER
HOT WATER
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Demodex Folliculorum
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ROSACEA TREATMENTS
TOPICAL METRONIDAZOLE & ANTIBIOTICS
SYSTEMIC ANTIBIOTICS
BRIMONIDINE GEL
COSMETIC COVERUP
LASER ABLATION OF VESSELS
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Brimonidine Treatment
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