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  • January 14, 2022

    By Allison Larson, MD

    Whether you’re a winter sports enthusiast or spend the season curled up by the fireplace, the low humidity, bitter winds, and dry indoor heat that accompany cold weather can deplete your skin’s natural moisture. Dry skin is not only painful, uncomfortable, and irritating; it also can lead to skin conditions such as eczema, which results in itchy, red, bumpy skin patches. 


    Follow these six tips to prevent and treat skin damage caused by winter dryness.


    1. Do: Wear sunscreen all year long.

    UV rays can easily penetrate cloudy skies to dry out exposed skin. And when the sun is shining, snow and ice reflect its rays, increasing UV exposure. 


    Getting a sunburn can cause severe dryness, premature aging of the skin, and skin cancer. Snow or shine, apply sunscreen before participating in any outdoor activity during the winter—especially if you take a tropical vacation to escape the cold; your skin is less accustomed to sunlight and more likely to burn quickly.


    The American Academy of Dermatology (AAD) recommends sunscreen that offers protection against both UVA and UVB rays, and offers a sun protection factor (SPF) of at least 30.


    That being said, if you are considering laser skin treatments to reduce wrinkles, hair, blemishes, or acne scars, winter is a better time to receive these procedures. Sun exposure shortly after a treatment increases the risk of hyperpigmentation (darkening of the skin), and people are less likely to spend time outside during the winter.


    Related reading: 7 Simple Ways to Protect Your Skin in the Sun

    2. Do: Skip products with drying ingredients.

    Soaps or facial products you use in warm weather with no issues may irritate your skin during colder seasons. This is because they contain ingredients that can cause dryness, but the effects aren’t noticeable until they’re worsened by the dry winter climate.

    You may need to take a break from:

    • Anti-acne medications containing benzoyl peroxide or salicylic acid
    • Antibacterial and detergent-based soap
    • Anything containing fragrance, from soap to hand sanitizer

    Hand washing and the use of hand sanitizer, which contains a high level of skin-drying alcohol, cannot be avoided; we need to maintain good hand hygiene to stop the spread of germs. If your job or lifestyle requires frequent hand washing or sanitizing, routinely apply hand cream throughout the day as well.


    During the COVID-19 pandemic, I have seen a lot of people develop hand dermatitis—a condition with itchy, burning skin that can swell and blister—due to constant hand washing. Sometimes the fix is as simple as changing the soap they're using. Sensitive-skin soap is the best product for dry skin; it typically foams up less but still cleans the skin efficiently.


    3. Do: Pay closer attention to thick skin.

    Areas of thin skin, such as the face and backs of your hands, are usually exposed to the wind and sun the most. It’s easy to tell when they start drying out. But the thick skin on your palms and bottoms of your feet is also prone to dryness—and tends to receive less attention.


    When thick skin gets dry, fissures form. You’ll see the surface turn white and scaly; then deep, linear cracks will appear. It isn’t as pliable as thin skin. When you’re constantly on your feet or using your hands to work, cook, and everything in between, dry thick skin cracks instead of flexing with your movements. 


    To soften cracked skin, gently massage a heavy-duty moisturizer—such as Vaseline—into the affected area once or twice a day. You can also talk with your doctor about using a skin-safe adhesive to close the fissures and help them heal faster.


    Related reading:  Follow these 5 Tips for Healthy Skin

    4. Don’t believe the myth that drinking more water will fix dry skin.

    Contrary to popular belief, the amount of water or fluids you drink does not play a major role in skin hydration—unless you’re severely dehydrated. In the winter, especially, dry skin is caused by external elements; it should be treated from the outside as well. 


    The best way to keep skin hydrated and healthy is to apply fragrance-free cream or ointment—not lotion—to damp skin after a shower or bath.
    Some people need additional moisturizers for their hands, legs, or other areas prone to dryness.

    While some lotions are made better than others, most are a combination of water and powder that evaporates quickly. Creams and ointments work better because they contain ingredients that can help rebuild your skin barrier. 

    Look for products with ceramide, a fatty acid that helps rebuild the fat and protein barrier that holds your skin cells together. The AAD also recommends moisturizing ingredients such as:

    • Dimethicone
    • Glycerin
    • Jojoba oil
    • Lanolin
    • Mineral oil
    • Petrolatum
    • Shea butter

    For severely dry skin, you can try a “wet wrap” technique:

    1. Rinse a pair of tight-fitting pajamas in warm water and wring them out so they’re damp, not wet.
    2. Apply cream or ointment to your skin.
    3. Put on the damp pajamas, followed by a pair of dry pajamas, and wear the ensemble for several hours.

    Dampness makes your skin more permeable and better able to absorb hydrating products. If the wet wrap or over-the-counter products aren’t working for you, talk with a dermatologist about prescription skin hydration options. 

    Drinking more water isn’t the answer to dry winter skin. The best solution is to apply fragrance-free cream or ointment directly to damp skin. Get more cold weather #SkinCareTips from a dermatologist in this blog: https://bit.ly/3KbVUA1.
    Click to Tweet

     

    5. Don’t confuse skin conditions with dryness.

    Skin conditions are often mistaken for dry skin because peeling or flaking are common symptoms. Redness of the skin or itching in addition to dryness and flaking indicates a skin condition that may need more than an over-the-counter moisturizer.


    Skin cells are anchored together by a lipid and protein layer (like a brick and mortar wall). With very dry skin, the seal on this wall or barrier is not fully intact and water evaporates out of the skin’s surface. The skin will become itchy and red in addition to scaly or flaky. If you experience these symptoms, visit with a dermatologist.

    6. Don’t wait for symptoms to take care of dry skin.

    Be proactive—the best way to maintain moisture is to apply hydrating creams and ointments directly to your skin on a regular basis. Start by applying them as part of your morning routine. Once you get used to that, add a nighttime application. And carry a container of it when you’re on the go or keep it in an easily accessible location at work.

     

    You can’t avoid dry air, but you can take precautions to reduce its harsh effects on your skin. If over-the-counter products don’t seem to help, our dermatologists can provide an individualized treatment plan. Hydrated skin is healthy skin!


    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

    Call 202-877-DOCS (3627) or Request an Appointment

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  • May 30, 2018

    By MedStar Health

    Congratulations to all MedStar researchers who had articles published in May 2018. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research.

    View the full list of publications on PubMed.gov here.

     Selected research:

    1. Nonacetaminophen Drug-Induced Acute Liver Failure.
      Clinical Liver Disease, 2018. DOI: 1016/j.cld.2018.01.006
      Thomas AM, Lewis JH
    2. Radioiodine refractory differentiated thyroid cancer.
      CriticalReviews in Oncology/Hematology, 2018. DOI: 1016/j.critrevonc.2018.03.012
      Jin Y, Van Nostrand D, Cheng L, Liu M, Chen L
    3. Prescription Drug Shortages: Implications for Ambulatory Pediatrics.
      Journal of Pediatrics, 2018. DOI: 1016/j.jpeds.2018.04.008
      Donnelly KA, Zocchi MS, Katy TA, Fox ER, van den Anker JN, Mazer-Amirshahi ME
    4. Principles of Billing for Diagnostic Ultrasound in the Office and Operating Room.
      The Journal of Hand Surgery, 2018. DOI: 1016/j.jhsa.2018.03.034
      Grasu BL, Wolock BS, Sedgley MD, Murphy MS
    5. Risk factors for opioid overdose among hospitalized patients. 
      Journal of Clinical Pharmacy and Therapeutics, 2018. DOI: 10.1111/jcpt.12701
      Vu Q, Beselman A, Monolakis J, Wang A, Rastegar D
  • May 30, 2018

    By MedStar Health

    A MedStar research study has found that in 15- to 44-year-old women who receive Medicaid, both implantable long-acting reversible contraceptives and intrauterine devices had high continuation rates and low complication rates after one year of use.

    “Continuation of long-acting reversible contraceptives among Medicaid patients” was a retrospective study recently published in Contraception. The research team was Max Romano, MD; Patryce A. Toye, MD; and Loral Patchen, PhD, MSN, MA, CNM. This collaborative research was conducted and supported by researchers at MedStar Franklin Square Medical Center, MedStar Washington Hospital Center, MedStar Family Choice, and MedStar Health Research Institute. 

    Unintended pregnancy is a major health concern in the United States despite increasing availability of effective contraception. The goal of this research was to compare continuation rates of different types of long-acting reversible contraceptives based on insurance claims data within the MedStar Family Choice Medicaid program in Maryland and Washington, D.C., 

    The cohort of 3103 women from ages 15 to 44 received long-acting reversible contraceptives between 2012 and 2015, including 1335 subdermal drug-eluting implants and 1970 intrauterine devices (IUDs). The research found that in young women (age 15 to 19), there was a higher rate of implant over IUD usage.

    The analysis found that there was a higher continuation of use for those who received implants as compared to IUDs. Continuation rates were not significantly different for implants versus IUDs among subjects 15 to 19 years old. Patients 20 to 24 years old using either implants or IUDs had lower continuation rates than younger and older subjects in the first year of use. “This may be due to higher rates of early discontinuation for desired pregnancy, to greater sensitivity to adverse side effects, or to other unique characteristics of this age group,” said the study authors.

    Both contraception options had low rates of claims for complications, with no statistically significant difference between the two types. The researchers also noted that most providers who inserted the long-action contraceptives were obstetricians, gynecologists, and midwives (2412 out of the 3305 cases).

    Future studies on this topic can address the noted selection bias. The study noted that they found “clear differences among provider specialties and LARC use, which may suggest differences in patient populations as well as in patterns of care.” This study was also limited to a specific population of one Medicaid plan, however, one strength was that all care interactions that resulted in claims were part of the data set, regardless of the medical institution that the patient visited.

    “I believe this research represents the exceptional collaborative opportunity in our integrated academic health system,” said Loral Patchen, PhD, MSN, MA, CNM, who is vice chair of Obstetrics and Gynecology and executive director of the Teen Alliance for Prepared Parenting (TAPP) Program at MedStar Washington Hospital Center.

    This research was included in the Advancing Health Report as part of the “Resident and Fellows Raise the Bar” section. This research was also presented at the 6th MedStar Health Research Symposium on May 1, 2017, and placed third for resident submissions in the post-graduate years 1-3 category.

    This work was financially supported by MedStar Family Choice, a Medicaid managed care organization operating in Maryland and Washington, D.C., The funder supplied insurance claims data for the project and provided oversight for the analysis, interpretation, and writing of the final manuscript.

    Contraception, 2018. DOI: 10.1016/j.contraception.2018.04.012

  • May 30, 2018

    By MedStar Health

    Researchers from MedStar Cardiovascular Research Network and MedStar Washington Hospital Center published an international study on a second-generation drug-eluting stent, finding positive and stable outcomes for a bioabsorbable stent in heart patients. “In vivo serial invasive imaging of the second-generation drug-eluting absorbable metal scaffold (Magmaris - DREAMS 2G) in de novo coronary lesions: Insights from the BIOSOLVE-II First-In-Man Trial” was published in the International Journal of Cardiology.

    A metallic stent, or scaffold, is a small wire mesh tube that is used to hold open coronary artery to increase blood flow to the heart. Since the development of the first metallic stents in the 1980s, there have been continued improvements in the use of technology for better patient outcomes. Bioresorbable scaffolds are considered a major advancement, designed to decrease the issues found with metallic stents including inflammation and prevention of future surgeries.

    The study looked at the imaging results of the 123 participants from eight countries in this first-in-man study. The study evaluated the stent scaffold and the treated coronary vessel through imaging comparisons of baseline, 6-month and 12-month data. The study did find that angiographically assessed coronary vessel curvature was preserved from pre-procedure to the 12 month follow-up period. Imaging included intravascular ultrasound-derived radiofrequency data analysis and echogenicity for evaluation. Through the use of radiofrequency data, the study found dense calcium decreased significantly from post-procedure at 6 months and at 12 months. A build-up of calcium in the heart can lead to a significantly greater risk for heart disease.

    “The drug-eluting absorbable metal scaffold DREAMS 2G showed a continuous favorable safety profile and stable performance outcomes up to 12 months,” the study stated. The study concludes that “following the implantation of DREAMS 2G, restoration of the vessel geometry, vasomotion, and bioresorption signs were observed at up to 12 months; importantly, these changes occurred with preservation of the lumen size between 6 and 12 months.”

    This research publication was lead by Hector M. Garcia-Garcia, MD, PhD. The research team included Michael Haude, MD; Kayode Kuku, MD; Alexandre Hideo-Kajita; Hüseyin Ince, MD; Alexandre Abizaid, MD; Ralph Tölg, MD; Pedro Alves Lemos, MD; Clemens von Birgelen, MD, PhD, FSCAI, FESC; Evald Høj Christiansen, PhD; William Wijns, MD, PhD; Javier Escaned, MD, PhD; Jouke Dijkstra, PhD; and Ron Waksman, MD. Dr. Garcia-Garcia is the director of angiographic, intravascular ultrasound, optical coherence tomography and near-infrared spectroscopy imaging at the Cardiovascular Core Laboratory, MedStar Cardiovascular Research Network, MedStar Washington Hospital Center (MWHC).

    International Journal of Cardiology, 2017. DOI: 10.1016/j.ijcard.2017.12.053

  • May 29, 2018

    By MedStar Health

    Did you know that Maryland ranks among the states with the highest number of confirmed cases of Lyme disease? The most common infectious disease spread by the bite of ticks, Lyme disease is also more likely to be contracted in late spring through early fall. So if you live here, it's important to take precautions against Lyme disease, particularly in the summer months.

    “Lyme disease is caused by bacteria that is transmitted to humans through the bite of infected black-legged ticks, sometimes called deer ticks,” explains Ericson Catipon, MD, a specialist in internal medicine at MedStar Harbor Hospital. “Typical symptoms include fever, headache, fatigue, and a ‘bulls-eye’ shaped skin rash. If left untreated, the infection can spread to joints, the heart, and the nervous system.”

    Most cases of Lyme disease can be cured with a few weeks of antibiotics, especially when treatment is started early. However, many cases of Lyme disease are misdiagnosed, often resulting in debilitating symptoms that can last for years.

    “Lyme disease is difficult to identify because it mimics many other disorders. It is diagnosed based on symptoms, physical findings such as a rash, and the possibility of exposure to infected ticks. Laboratory testing is helpful if done correctly, but not all providers are familiar with the methodology, which can lead to false positives,” says Dr. Catipon.

    “As a result, some individuals end up being treated for Lyme disease rather than the condition that is the source of their symptoms. In addition, providers who trained in geographical areas where Lyme disease is not prevalent may not think to test for the infection,” he notes.

    The risk of exposure to ticks is greatest in the woods and in the edge area between lawns and woods. However, ticks can also be carried by animals onto lawns and gardens and into houses by pets.

    Steps to prevent Lyme disease include using insect repellent, applying pesticides, reducing tick habitat, and wearing long pants and sleeves to keep ticks off the body when outdoors. If a tick is found it is important that it be removed as soon as possible using fine-tipped tweezers.

    Lyme disease was first recognized in the United States in 1975 after an unusual outbreak of arthritis near Lyme, Connecticut. Today, over 30,000 cases of Lyme disease are reported to the Centers for Disease Control and Prevention each year, though the true number of infections is thought to be much higher.

    “Untreated Lyme disease can be very serious,” Dr. Catipon adds. “If you develop any of the symptoms associated with Lyme disease after a tick bite or being in a tick habitat, contact your healthcare provider.”

    For more information, please call

    410-350-8222

    MedStar Harbor Primary Care
    MedStar Harbor Hospital Outpatient Center, Suite 300
    3001 South Hanover St.
    Baltimore, MD 21225

  • May 29, 2018

    By MedStar Health

    Task Force Unites Community to Break Down Barriers

    MedStar Harbor Hospital is fully committed to meeting the healthcare needs of its community. But knowing exactly what those needs are, and putting the right programs and services in place to meet them, can require a bit of research.

    That’s the focus of the MedStar Harbor Hospital Community Health Needs Assessment Task Force, which brings hospital leaders and physicians together with representatives from the Baltimore City Health Department, Baltimore City government, and other local non-profits, for open discussion and dialogue about healthcare resources that exist, or don’t but need to, in our community. Along with these discussions, the task force collects insight from the public through surveys and community input sessions.

    “MedStar Harbor is one of the anchor institutions in the city for healthcare services,” says Ryan Moran, who serves as the hospital’s director of Community Health. “It’s important that we assess what people are experiencing in a way that directly involves them and then respond to fill those gaps.”

    Most recently, the task force identified an increasing need for behavioral health and chronic disease management services in the communities that surround MedStar Harbor. Moran says that the hospital is putting new programs and resources in place in response to this. One of the most significant investments has been the development and launch of a Peer Recovery Coach Program. This program is designed to provide support, guidance, and a path to recovery for individuals with substance abuse or addiction issues.

    Jerry Gross is one of three peer recovery coaches the hospital now employs through grant funding from the Baltimore Population Health Workforce Collaborative. If and when a patient screens positive for substance use in the Emergency department, Gross’ job is to engage that person in a supportive, no-judgement conversation. He attempts to first gain their trust by explaining that earlier in his life, he was in their shoes.

    “Fifteen years ago, I was addicted to drugs and alcohol, and I lost everything because of it,” Gross explains. “I got help and turned my life around. And now I am so fortunate that I get to help others. Being able to make that first connection with someone is so important. That’s what I needed a long time ago. And that’s what I am giving now.”

    Moran says that MedStar Harbor offers a number of health education programs and classes to give people additional resources to help them prevent and manage chronic diseases and pursue healthier lifestyles.

    “By creating better access to care, we can play a significant role in helping people get well and stay well,” said Moran. “That is what the Community Health Needs Assessment Task Force is really setting out to accomplish.”

    In addition to the Emergency department, peer recovery coaches provide services in the inpatient behavioral health and mother and infant services units.

  • May 29, 2018

    By Matthew L. Pierce, MD

    Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S.—it’s so prevalent that nearly all sexually active men and women will get the virus at some point in their lives.

    There are many different strains of HPV and while certain strains can cause cervical cancer in women, most who are infected with the virus will never have symptoms or know they have it. Other strains, such as HPV-16, have been associated with up to 70 percent of cancer in the oropharynx, which includes the back of the throat, the base of the tongue and the tonsils. And perhaps surprisingly, these cancers are spiking among younger and healthier adults.

    LISTEN: Dr. Pierce discusses the link between head and neck cancers and HPV in the Medical Intel podcast.

    Who’s at risk for head and neck cancer from HPV?

    HPV-related cancers of the head and neck occur in the oropharynx and less commonly in the larynx, or voice box.

    Among those who are infected with the HPV16 strain, only a small number actually develop cancer. There is ongoing research to learn why some people develop it and others don’t. But healthy, non-smoking individuals between 35 and 55 are the fastest-growing segment of the oropharyngeal cancer population. In these patients, cancer occurs in males more than females, at a rate of about three to one.

    Head and neck cancers can be difficult for patients to cope with because they can affect aspects of day-to-day life, body features and the organs that help us communicate. These challenges can have negative effects on a patient’s mental well-being and quality of life:

    • Altered appearance, due to changes to skin, tissues or facial structures
    • Difficulty swallowing, which can affect eating and drinking, and involuntary swallowing, such as during sleep
    • Speech or voice impairment

    The good news is that head and neck cancers caused by HPV respond better to treatments and have a much better prognosis than other cancers of the head and neck. In fact, HPV-positive patients have half the risk of death compared with patients whose head and neck cancers weren’t caused by HPV. Researchers also are investigating de-escalation, or a reduction in the amount of treatment we give to these patients, while still maintaining the same good outcomes.

     
    Head and neck cancers can affect young, healthy people due to #HPV. The good news is these cancers often respond well to treatment. bit.ly/2st8jbU via @MedStarWHC

    Click to Tweet

    What are the symptoms?

    Some of the symptoms of HPV-related head and neck cancer may initially be attributed to other benign conditions, or they may be somewhat subtle, such as:

    • Coughing up blood or nosebleeds
    • Difficulty or pain in swallowing
    • Difficulty speaking or changes in your voice
    • Ear pain
    • Hoarseness

    For most patients with HPV-related cancer, the symptoms are less subtle and include a mass in the neck or a lesion in the mouth that does not heal. At this time, there is no screening approved by the Food and Drug Administration (FDA) that has been shown to reduce the risk of developing or dying from oropharyngeal cancer. I urge you to make an appointment with your doctor or see a specialist if any of these symptoms last for more than two or three weeks without improvement.

    Can HPV be prevented?

    The best line of defense against HPV is to avoid the virus in the first place, and the best way to do that is with the HPV vaccine. We expect vaccinations to decrease the amount of cancers we see in the future. The Centers for Disease Control and Prevention (CDC) has the following recommendations for the HPV vaccine:

    • Females and males 11 to 12 (can start at nine)
    • Females 13 through 26 and males 13 through 21 who were not adequately vaccinated previously
    • Males 22 through 26 who have certain immunocompromising conditions or who have sex with men
    • Transgender people who were not adequately vaccinated previously

    After age 26 for women and 21 for men, patients can avoid HPV infection but not completely prevent it with a vaccine. I give patients the same advice to avoid HPV as any sexually transmitted disease: use condoms and dental dams. Even someone in a monogamous relationship has the risk of being exposed from their partner’s past partners, and even open-mouth kissing potentially can spread HPV.

    When a patient develops an HPV-related cancer, we use a team approach to treat them. Many specialties work together to provide whole-patient care and achieve the most effective outcome. We bring ear, nose and throat doctors, head and neck cancer surgeons and chemotherapy and radiation doctors together in a meeting called a tumor board to discuss each patient’s condition and management options. This benefits the patient with a well-rounded approach and ensures that every angle is considered before we recommend a treatment decision.

    If surgery is needed, we often can use minimally invasive robotic techniques to reduce scarring and recovery time. After treatment, we connect patients with specialists to maximize their recovery, such as speech pathologists and palliative care specialists for pain management.

    The medical community is making great progress in the fight against head and neck cancers caused by HPV. We have effective treatments for patients who have these cancers, and I’m confident that these diseases will become less common as more young people get vaccinated against HPV.

    Call 202-877-3627 or click below to make an appointment with an otolaryngologist.

    Request an Appointment