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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 02, 2021

    By MedStar Health

    Congratulations to all MedStar researchers who had articles published in April 2021. 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. The Impact of Smoking on Early Postoperative Complications in Hand Surgery
      Journal of Hand Surgery, 2021.DOI: 10.1016/j.jhsa.2020.07.014
      Cho BH, Aziz KT, Giladi AM. 

       

    2. Comparison of Characteristics and Outcomes of Patients With Acute Myocardial Infarction With Versus Without Coronarvirus-19
      The American Journal of Cardiology, 2021. DOI: 10.1016/j.amjcard.2020.12.059
      Case BC, Yerasi C, Forrestal BJ, Shea C, Rappaport H, Medranda GA, Zhang C, Satler LF, Ben-Dor I, Hashim H, Rogers T, Waksman R.
    3. Providing Care for Caregivers During COVID-19
      American Journal of Nursing, 2021. DOI: 10.1097/01.NAJ.0000749752.80198.c0
      Morales C, Brown MM.

    4. Does Scalp Cooling Have the Same Efficacy in Black Patients Receiving Chemotherapy for Breast Cancer?
      The Oncologist, 2021. DOI: 10.1002/onco.13690
      Dilawari A, Gallagher C, Alintah P, Chitalia A, Tiwari S, Paxman R, Adams-Campbell L, Dash C.

       

    5. Representation Matters: An Assessment of Diversity in Current Major Textbooks on Burn Care.
      Journal of Burn Care and Research, 2021. DOI: 10.1093/jbcr/irab066 
      Shivega WG, McLawhorn MM, Tejiram S, Travis TE, Shupp JW, Johnson LS.
  • May 02, 2021

    By MedStar Health

    This collaborative research project sought to develop a framework to assess the risk of conducting clinical trial activity during the COVID-19 pandemic in rural, low resource settings. This research specifically looked at the continuation of the multi-country Household Air Pollution Intervention (HAPIN) trial, which is a randomized controlled trial in rural areas of Guatemala, India, Peru, and Rwanda that is assessing the health benefits of providing liquefied petroleum gas (LPG) stoves and an 18-month supply of free LPG to 3200 households that otherwise depend on solid biomass fuel (wood, animal dung, or crop residue) for cooking. While the study was conducted overseas, it has application for any rural area.

    In 2020, the spread of COVID-19 led to the temporary suspension of many non-COVID-19 related research activities worldwide. Where restarting research activities is permitted, investigators need to evaluate the risks and benefits of resuming data collection and adapt procedures to minimize risk. The goal of this study is to maximize the integrity of research aims while minimizing infection risk based on the latest scientific understanding of the virus.

    The HAPIN study collects measurements of cooking behavior, personal and in-home exposure to air pollution, biological samples and clinical measurements from pregnant women and their newborns in every household, along with an older, non-pregnant adult woman, if she resides in the house. The study involves home visits, as well as visits to health centers and hospitals during the woman’s pregnancy and the first year of the child’s life.

    In developing the risk assessment tool in the context of COVID-19, the research team used a combination of expert consultations, risk assessment frameworks, institutional guidance and literature and systematically graded clinical, behavioral, laboratory and field environmental health research activities in four countries for both adult and child subjects using this framework.

    The framework assessed risk based on staff proximity to the participant, exposure time between staff and participants, and potential viral aerosolization while performing the activity. For each activity, one of four risk levels, from minimal to unacceptable, was assigned and guidance on protective measures was provided.

    The researchers assessed research activities that included LPG fuel delivery, administration of tablet-based surveys, data downloads from environmental monitors, personal exposure assessment to household air pollution, biological sample collection (e.g. urine, nasal swabs, venous blood) and lab processing of biological samples in the field laboratories, clinical, observations in homes of pregnant women/new mothers, children, and vascular procedures in adults.

    The study results show that almost all of the research activities were deemed to pose potentially manageable risks. The activities with the highest level of risk were those that potentially aerosolize the virus during the procedure.

    The study team concluded that by applying a systematic, procedure-specific approach to risk assessment for each research activity, it can minimize the disruption in trials due to the pandemic and continue to protect participants and research team and support the completion of primary outcomes. The study team also believes their framework can be applied be tailored to other research studies conducted in similar settings during the current pandemic to guide investigators in assessing the risk of each research activity and implementing appropriate safety measures, where the level of risk is acceptable.

    This research was led by one of our newest MedStar Health investigators, Suzanne M. Simkovich MD, MS, Physician Investigator, MedStar Health Research Institute, Assistant Professor of Medicine, Georgetown University.

  • May 01, 2021

    By MedStar Health

    What is HIPAA?

    The Health Insurance Portability and Accountability Act (“HIPAA”) governs how healthcare data is shared, both in terms of research and in medical care.  It has several components, which govern specific situations.

    • Security Rule (45 CFR Part 164): Safeguards to ensure confidentiality, integrity, availability of electronic PHI
    • HITECH: Debuted “Breach Notification Rule,” increased penalties for non-compliance
    • HHS Omnibus Rule: Extended regulations directly to business associates, required subcontractor compliance
    • Breach Notification Rule: Sets rules for notification to HHS and to individuals in the event of breach

    Who does HIPAA apply to?

    Health Plans (i.e., insurers), Clearinghouses (“billing services”), and Health Care Providers, including hospitals are considered covered entities for HIPAA. This means that they are required to follow the rules and regulations of HIPAA.

    In addition, HIPAA can apply to business associates. Business associates are considered persons that create, receive, maintain, or transmit protected health information on behalf of a covered entity or another business associate. The role of business associates is to support the ability of a covered entity to execute on its ability to provided healthcare, and their access to health information is limited to what is necessary to support that work. This work can include payments/healthcare operations activities, claims processing, utilization review, quality assurance, and data analysis/aggregation. HIPAA does not consider research to be a business associate function.

    HIPAA Privacy Rule

    Protected Health Information is defined as “individually identifiable health information held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral communication”. This data can be in the context of an individual’s past, present, or future physical or mental health condition; or provision of health care to the individual; or past, present or future payment for providing health care to the individual. It contains enough detail that there is a reasonable basis to believe that the information can be used to identify the individual.

    Under HIPAA, a covered entity may not use of disclose protected heath information, except as the privacy rule permits or requires, or the individual whose protected health information it is provides written authorization.

    There are specific instances where disclosure is permitted without authorization, but those are limited to:

    • To the individual
    • Treatment, Payment, Healthcare Operation
    • Public Interest and Benefit Activities (which includes research with waiver)
    • Limited Data Set (with a Data Use Agreement)

    Use and Disclosure of Protected Health Information for Research

    With authorization (i.e., HIPAA Authorization embedded into or separate from the Informed Consent Form), protected heath information can be used for research purposes.

    If the research team does not seek authorization from individuals, protected heath information can be accessed through the following processes:

    • Documented IRB/Privacy Board Approval of an alteration or waiver of the requirement to obtain an individual’s authorization.
    • Representations from researcher that use or disclosure of PHI is solely for a purpose preparatory to research (i.e., preparing a protocol)
    • PHI of Decedents
    • Limited Data Set

    De-identified data is not considered protected heath information and not regulated by the Privacy Rule.

    Questions?

    If you have questions specific to your research, please contact our Office of Research Integrity at MHRI-ORIHelpDesk@medstar.net. If you have questions regarding data use agreements, business associates, or other contract vehicles for research, contact our Office of Contracts and Grants Management at MRI-OCGM@medstar.net.

  • April 29, 2021

    By MedStar Health

    While many MedStar Washington Hospital Center associates can trace their careers back to the beginning at our hospital, not many started here as a student like Robert Molyneaux. It was 1981 when Robert came for a rotation with MedSTAR Trauma as a physician assistant (PA) student. His learning experience taught him not only the skills to become a PA, but also that this was a place he would want to return to during his career. After a stop at Capitol Hill Hospital (a part of Medlantic Healthcare Group, a pre-cursor to MedStar Health) as a surgical and hospitalist PA, and Prince George’s Hospital Center’s Critical Care unit as a critical care PA, Robert came back to MedStar Washington in 1995.

    Here, Robert has worked in Surgical Critical Care and the Cardiovascular Recovery Room, advancing to become chief PA for Surgical Critical Care in 1999. He worked on initiatives that brought professional growth to our advanced practice providers (APPs) and helped reduce the hospital’s central line-associated bloodstream infection (CLABSI) rate. He also helped establish the Procedure Service in 2012 and write the job description for the position he would take on next.

    Because of these initiatives, Robert became the clinical director of the Procedure Service, a job that fit in perfectly with his lifestyle as a father of teenagers. His job gave him the flexibility to get his children off to school before coming in to work. In this role, Robert was also part of a team that drastically reduced CLABSI by 85%.

    One key to Robert’s success has been learning from other leaders. One leader who became a mentor, Arthur St. Andre, MD, taught Robert lessons on how to take what he calls “well-intentioned” risks, make mistakes, and grow from those lessons. He says he continues to get similar support from the director of Critical Care, Alexandra Pratt, MD.

    “The Hospital Center provides a lot of training for leaders,” said Robert. “This is an innovative staff and we implemented management and leadership techniques that allow leaders to grow because of what is offered here.”

    Robert said he has enjoyed his career at MedStar Washington, is humbled and appreciative of his colleagues who helped reduce CLABSI, and will always appreciate the hospital where his wife was born and where his career thrived.


    Looking for a new career opportunity?

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  • April 27, 2021

    By MedStar Health

    Compassion is a requirement for every medical specialty, but some specialties require doctors to have an exceptional ability to listen to patients’ most hard-to-talk-about problems. Candid conversations about issues surrounding urination and sexual matters can be difficult for many patients.

    These sensitive, highly personal conversations are what led Rachael Sussman, MD, to choose urology for her medical specialty. She is the first female urologist at MedStar Washington Hospital Center Urology, and one of only 10 percent nationwide.

    For men and women, urology deals with diseases of the urinary tract, from the kidneys that clean the blood and extract the urine, to ureters that carry urine to the bladder for storage, and on to the urethra that carries urine out of the body. For men, urology also deals with the male reproductive organs, including the penis, testicles and prostate gland.

    Problems with urination and leakage of urine are common and can greatly impact a person’s quality of life. Honest, open conversations can lead to solutions that dramatically improve a person’s life. “Urology gives me a good opportunity to make people happy,” Dr. Sussman explains. “I like to focus on these quality-of-life issues where I can help people.”

    Some of the more common conditions she treats are urinary leakage, frequent urination or an urgent need to urinate—changes that many men and women experience as they get older. For women, these conditions can be a result of childbearing. For men, these conditions can result from an enlarged prostate, which also may be due to aging.

    After training as a urologist, Dr. Sussman completed a fellowship in female pelvic medicine, also called urogynecology, a specialty that treats women with urinary problems that result from uterine prolapse and other conditions associated with aging and childbearing. Highly specialized surgeries can offer relief by lifting sagging structures and restoring vaginal anatomy.

    Whatever the cause, Dr. Sussman uses a step-by-step approach to identify the best treatment. “I use the least invasive treatment methods first,” Dr. Sussman explains. This can include exercises to strengthen the muscles that control urination plus other behavioral approaches. Medications can also be used to relax the bladder or improve the flow of urine.

    “We tailor our treatments to each patient’s goals and desires,” she says. That’s where her sensitivity and compassion come into play. When it comes to the treatment of pelvic organ prolapse in women, she is an expert in vaginal surgery, which allows her to treat problems without any visible incision. She also offers robotic surgery that can be performed through tiny incisions, which reduce pain and speed recovery. Men with enlarged prostates also benefit from new treatments. For example, a laser treatment can help reduce the size of the prostate to ease urination with a lower risk of bleeding than traditional surgery.

    Dr. Sussman is part of a urology practice at MedStar Washington Hospital Center that includes seven urologists. “The value of a large urology practice is that each of us can be really specialized in what we do and stay up to date on the newest findings in the practice of urology. Patients can be sure that they have access to the best specialist for their particular condition.”

    It’s never too early to seek treatment, Dr. Sussman concludes. “Things change as we age,” she says. “Early intervention can help problems from becoming worse over time. There are a lot of new treatments that are very effective.”


    Experiencing urinary issues?

    Connect with our urology team today.

    Call 202-788-5048 or Request an Appointment

  • April 23, 2021

    By MedStar Health

    A viable surgical treatment for deep vein post-thrombotic syndrome (PTS) and similar obstructive venous conditions is being pioneered by MedStar Heart & Vascular Institute’s Steven Abramowitz, MD.  

    Using a reconstructive technique called endovenectomy, Dr. Abramowitz carefully removes scar tissue from within a vein, which creates a clean channel for flow into an inserted stent, allowing blood to flow freely. “The procedure requires a connection between healthy sections of the vein,” says Dr. Abramowitz. “Usually a clean path, just over three inches, is all we need.” 

    Post-thrombotic syndrome is an under-recognized disease that affects patients’ quality of life, says Vascular Surgeon Misaki Kiguchi, MD, who teams up with Dr. Abramowitz on some cases.  

    “After deep vein thrombosis, the scar that forms in the vein often narrows the channel in which blood can flow back to the heart, increasing venous pressure in the legs. This leads to symptoms of heaviness, swelling, and in the most severe cases, ulcers. Dr. Abramowitz’s endovenectomy skill adds to the comprehensive venous team at MedStar Heart & Vascular Institute, by increasing the population of patients who can be treated endovascularly by adjuvant endovenectomy. These patients otherwise would have limited surgical options and limited success in revascularization without an endovenectomy.” 

    Dr. Abramowitz has used the procedure to treat PTS in the external iliac vein, femoral vein, and profunda vein. He reports that the two-to-four hour-long procedure has so far yielded good outcomes, and any patient with PTS is a candidate. 

    “Rather than having to rely on wound care and compression to treat chronic, non-healing venous wounds, we’re able to improve the patient’s own venous drainage, addressing the root of the problem,” Dr. Abramowitz says. “Many patients are healed within a matter of months.” 

    Dr. Abramowitz is using the results of adjuvant endovenectomy with endovascular stenting to study ways to refine the technique, from varying segment lengths to investigating ways to accelerate the healing process. Although there may also be ways endovenectomy can help address conditions in other parts of the body, Dr. Abramowitz says the procedure’s most promising area of treatment is in the legs, where deep vein clots and other occlusions most frequently occur. 

    Dr. Kiguchi adds, “At the MedStar Health Vein Centers, I treat a wide range of venous disease, from cosmetic varicose veins to large venous ulcers. Having a colleague like Dr. Abramowitz, and his success with endovenectomy to improve venous hypertension in many patients with PTS, is an asset to the comprehensive venous disease treatment paradigm.” 


    Swelling in the legs?

    Contact our vascular specialists today.

    Call 202-788-5048 or Request an Appointment