Dandruff & Keratosis and Moles---an overview! With Dermatologist, Dr David Reid

Dermatologist Dr David Reid joins Ask Dr Jessica to talk about common skin conditions that are chronic (stay around for a long time), like dandruff, Keratosis Pilaris and Moles.   Dr Reid explains the best treatment options for dandruff--like using selenium sulfide, Ketaconazole, or zinc pyrithione (or a combination thereof). He also gives tips on how to treat keratosis pilaris -- a common, harmless skin condition that causes dry, tiny bumps found often on the upper arms, thighs and cheeks.  And lastly, we talk about moles!  He gives a great overview on what moles are, and signs when to see a dermatologist. 

Dr David Reid is currently the Chief of Dermatology at Rush Medical Center in Chicago.  He completed his medical school degree at Harvard Medical School and his dermatology residency at Northwestern University.   He has been well published and has lectured internationally. 

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

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Transcript

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Hi everybody, welcome back to ask Dr. Jessica the podcaster My goal is to give quality medical information to help anyone out there who cares for children. On today's podcast, my guest is dermatologist Dr. David Reed. This episode is packed with clear practical advice about three skin conditions that I commonly see dandruff keratosis pilaris, otherwise known as k, p, and moles. Dr. Reid is a very accomplished dermatologist. He graduated from Harvard Medical School, he completed his dermatology training at Northwestern University, and he is currently the chief of dermatology at Rush Medical Centre. And a quick reminder before we get started, if you are enjoying this podcast, I would be so appreciative if you would share it with anyone who you think may benefit from learning this information. And thank you to anyone who has already left a five star review. I do read all of the comments and I truly appreciate them. All right, now on to the interview with Dr. David Reed, common question that I get that comes up Dandruff can you quickly touch upon how parents should approach dandruff and what things they can use to treat general dandruff. Absolutely such a common condition as well usually occurs it can occur in infants and then there's usually a break and it doesn't occur again until around the time when the oil glands are what are called the sebaceous glands become more active during puberty and so that occurs and then the dandruff or what we call the medical term for dandruff is Seborrheic Dermatitis so that flaking of the skin or the scalp I should say commonly sometimes you can get redness and itching as well can occur not only on the scalp, but the ears, the eyebrows, around the nose on the face, even sometimes the chest the back and other areas as well. So a variety of factors to consider there also another condition that can be inflammatory. There's a little micro organism that lives on the skin that is thought to play a role there. So some of the you know for mild dandruff or mild Seborrheic Dermatitis great over the counter products that one can start with a couple ingredients that are available in various forms that you can get would be things like Selenium sulphide, and that can come in a shampoo for example, or a cream or a lotion. Kido connoisseur is another great ingredient that can have activity against that micro organism. Zinc pure thyroid is another excellent ingredient. So shampoos for example, they have one of those three ingredients kita Khan azul, Selenium sulphide or zinc your thyroid is a is an excellent starting point and integrating that as part of the daily routes or however often one wants to use our shampoo the scalp, whether that's you know, a few times a week or even daily can be really effective, I will often recommend that patients alternate those so you don't have to just use one product you don't just have to use for example selenium sulphide shampoo, you can use that one day and then the next day you can use or two days later you can use a cute a connoisseur shampoo because then you get the benefit of two different ingredients two different mechanisms of action and in combination that can be really effective. Another tip I would give is that if you do have you know people sometimes don't make the association of the danger thinking on their scalp with the flaking they get on the eyebrows or around their nose or, or whatnot. And so that's the same condition and and they even get it on their chest sometimes. So you can use that same shampoo as a kind of a face wash, which some people think a shampoo is a face wash they always think that's a strange concept and I suppose it is but it's actually totally okay. You can use it around the eyebrows, kind of let it sit there for a few minutes and then rinse it off. You can use it around the nose the chest is considered like a cleanser it can be really effective there as well. To help with familiarity with those listening. If you've ever heard of head and shoulders or tea gel, those are the names of five products. Oh yeah, those are great. Neutrogena makes the products head and shoulders you know ketoconazole now natural shampoo are a couple of brands you know several different selsun Blue you know different different brand names there that you can you can look for the important thing would be to look for that active ingredient salicylic acid sometimes as a shampoo can be found that ingredient that I mentioned for acne can also be helpful because x is also a catalytic which means that it can thin out some of that flaking, especially if one has a lot of buildup of excessive flaking or, or excessive kind of skin on the scalp. For example, integrating something with a little salicylic acid which can be over the counter is shampoo can be really effective. And once they see improvement of dandruff, do you recommend keeping some of the shampoo in the routine? Yeah, because it tends to be also a chronic condition, you know, many of the conditions in dermatology that we confront are chronic. And so that's another common issue we face is that patients will, will will, or people will, will use something, it'll get better, and then it'll, you know, they'll stop it and it'll come right back again. And unfortunately, we don't have cures for some of these conditions, we don't have something, a pill or a cream that we can give, it'll just go away forever. But we do have great treatments that if we use them on an intermittent basis, we'll control it, so that you use them intermittently. And it kind of stays away. So set. So dandruff or seborrheic dermatitis is one of those conditions. So once you get it cleared up, you can start to decrease the frequency of how often you use the shampoo. And, you know, just find that frequency that works for you. Some people might, it might be once a week, just kind of slowly taper it down, as we say or decrease the frequency at which you use it. And it's a little bit of experimentation there to find what cadence or what frequency you need to use it at for it to be effective. And once you find that, you'll probably need to use it kind of off and on indefinitely to keep it away. If you're doing really well after a few months, and you want to try to stop it. That's okay, but just anticipate that it might come back and you might need to read back up again. Thank you so much for this, this is so helpful. Now moving on to a condition called keratosis pilaris. Or what we'll call often K P for short. Do you have a recommended treatment for families that have K p? Right? Yeah, so really common condition. Kind of like a version, I often will say of normal skin in a way it's not a it's not a skin disease, per se. It's more of a as a, just a different version of skin, because it's so common. And it's something that people, it's not dangerous to people but people often don't particularly care for. It's another condition that will be chronic. So it's something that needs to be continuously treated in order to keep it away. Really common. For example, on the upper arms, that's probably the most common area, kind of between the shoulder and the elbow. But you can occur in other areas too, including sometimes on the cheeks or the thighs or other areas. As far as products for that go, there's a few different products that are available. So one of them is called ammonium lactate, or a version of lactic acid, which is a kind of a version of a, again, what's called a catalytic or a version of a moisturiser that can you can acquire over the counter. There's also something called urea, which is another for lack of a better term moisturiser that one can acquire and use. And so using that on the skin to kind of thin that out and using it consistently every day is is a is a great choice. And those are available at lower concentrations over the counter. You know, amlactin makes, for example, a product Sara Bay makes a product called rough and bumpy. It's the app name for the condition. And it's a combination of product or ingredients that can be effective. So there's a number of great choices. But usually ammonium lactate urea are great, great products. And then if it's particularly bad, you can see a dermatologist and we can prescribe stronger concentrations of those products that can be effective. Sometimes the KP or the keratosis players can get a little inflammatory and a little red or even itchy and we use some anti inflammatories, either cortisone based medicines or if one does not want to use a cortisone based medicine, we can use a non steroidal alternative. And I like to point out to families that this really is more of a cosmetic issue correct. It doesn't itch kids, it doesn't bother kids. No, it typically doesn't present in number one is not dangerous, and typically is not symptomatic. Very seldom where you can be a little inflamed, as I said, maybe a little red, maybe a little itchy, but that vast majority. And if that's the case, we can maybe treat it a little bit with something anti inflammatory, but I would say the vast vast majority of kids not symptomatic in any way more of just the look or feel that is bothersome, but many people you know, just kind of don't don't even worry about it and kind of sometimes choose not to treat it's really personal choice, but if they want to treat it we do have options. Do you notice relationship with keratosis pilaris and eczema or genetics? For sure. Yeah, for sure. It is more Common and probably it has a genetic basis and is definitely more associated with eczema. So that's a common association we know that and so you know oftentimes with eczema of course or a topic dermatitis, a good moisturising regimen is really key and if that foundation of treatment, and so integrating that urea or that ammonium lactate in those areas is part of that, that treatment. Thank you. Now, lastly, a common general dermatology question that comes up in my paediatric practices moles. A lot of parents show me their children's moles, they want to know when to see a dermatologist. Can you touch upon moles? And what are concerning signs of moles and when they should draw attention to a dermatologist, right? So, you know, moles are, you know, something that develops, you know, naturally throughout the early stages of life, so, they are in and of themselves, not necessarily worrisome findings, I think some important considerations that, that parents should should think about is number one, family history of melanoma, for example. So with moles, what we really worry about are primarily, number one, first and foremost, melanoma. And so family history of melanoma is a consideration, we know that melanoma does have a genetic basis and is more common in first degree relatives. So considering the family history of melanoma is something that people should be aware of and take into account. There's different types of moles, there's congenital moles, which, which kids are born with. And those, you know, we usually consider those based on size and the smaller or medium size moles that the kids are born with, they will grow with time, and as a kid grows, they will grow naturally. And that's to be expected. So that's not worrisome in and of itself, and the risk of a mole of that site type developing in the melanoma is thought to be very, very low. So that's generally a reassuring thing. It's not zero, but it is quite low. And so, you know, in general, I would say that, just because someone has a mole, it doesn't mean necessarily anything terribly worrisome. Now, if someone has a kid has numerous moles, you know, over 50, or over 100, that does increase the risk of melanoma as well. So in those cases, that does that does warrant an evaluation and, and a visit with a dermatologist, or if someone has a very large mould. And something that is not that medium or small mould, but something that's very large, there is a bit of a higher risk of developing something in those moulds. So there's a reason to visit there. Now, beyond that, of course, every case is a little bit different. But I would say that some things to look for is one, you know, one can always have an evaluation for a mole and see a dermatologist. And, and, and give some reassurance if one would like. But the important things to look for are changes to the mole, that would reflect something different than just growth with the size of the child. So if the the growth is, or the mole is changing, in a way that is different than the just the overall growth of the kid, if it's growing at rapid rates, relative to the kid or if it's developing excessive kind of bumpiness, or colour change that looks out of proportion to the development of the kid as a whole. So it's normal for some level of of growth in some level of bumpiness. And maybe even some subtle colour change. But if it's turning multiple colours or developing a particular kind of area that's becoming really elevated or poor, ulcerated, or bleeding or something like that, those would be the things that you would really want to look for. Or if there's a worrisome family history, or numerous moles, I think those are all signs that wants you to see a dermatologist. So it sounds like rapid change is a definite red flag for concern. For sure. rapid change is probably the biggest one and and beyond that, you know, it's a little bit subjective, but I would say you know, most moles, a lot of melanoma develops in new moles, rather than pre existing moles. So we often will see moles, we'll track them and see how they're changing. But if they're stable, that's a really reassuring thing. Do you ever talk about the ABCs with patients? Oh, for sure. Yeah. So that's a really helpful guide and well published. You know, the eight the asymmetry. The Border variety, colour, diameter and then evolution. So the E is how it changes over time. So, you know, looking at those guides and one can can look that up very easily either on the ad or elsewhere, but certainly a really helpful way to remember kind of what to look for in a mole, and kind of consider and a general guideline that will help you know a person, think about when they might want to see a dermatologist, and actually think it's helpful for people listening to look up examples of what melanomas look like, because I think it'll give a frame of reference. Exactly. And, you know, there's obviously a range of the way they can look. And, you know, I think it's just helpful to give some idea of it. You know, if there's concern, we're always happy to look and always happy to consider things. And obviously, there are other types of things other than melanoma, that's not the only thing that's something could be there's other things like spirits nearby different things that can develop. A positive note, I like to tell parents is that recently, they found that melanoma is as rare as they are in children, they've even become more rare in the last 10 years. It's one of the few cancers where we've seen a decrease in prevalence in recent years. Yeah, that's, that's unusual, right? I mean, we're seeing increased prevalence and other areas. So that's encouraging. David, anything else you want to add? I think we touched on a number of great topics, a number of great over the counter products that hopefully your audience can can look for. But, you know, I think using those products are a great starting point. And then beyond that, always remember that if one is not seeing the results they need, I it's certainly really gratifying to us as dermatologists to be helpful to a patient or anyone who needs our help, even for something small or something that the patient might feel. Sometimes, like we see I see a patient who feels embarrassed or feels like maybe they're there, they shouldn't be there. I never ever feel that that's the case. So you know, if someone wants to make an appointment with the dermatologist, please do so. Because no matter what it is, we are here to help. We want to make people feel the best they can about themselves and I certainly why we entered the field and anything we can do in that regard. For Kids, for for parents, anybody. That's what we're here to do. Dr. Reid, thank you so much. Thank you for listening, and I hope you enjoyed this week's episode of Ask Dr. Jessica. Also, if you could take a moment and leave a five star review wherever it is you listen to podcasts, I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr. Jessica See you next Monday.