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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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  • January 15, 2016

    By MedStar Health

    Patients often tell us- remarkable care is what sets a healthcare facility apart. Here’s a snapshot of some of the people at our hospital who are providing phenomenal comfort and care to our patients, especially when they need it most. Read their stories and note how they’re making a difference each day.
  • January 07, 2016

    By MedStar Health

    Congenital Heart Defects Detective

    The device is thinner than a flash drive, elegantly streamlined and slanted at the edges like the latest smart phones. Cardiologist Margaret Bell Fischer, MD, holds the tiny steel implantable loop recorder between her thumb and forefinger as she explains the many ways this wireless device, inserted under the skin in a brief, one-suture procedure, provides important clues for her patients.

    Clues are pivotal for Dr. Fischer, a cardiac electrophysiologist who treats pediatric and adult cardiac patients and specializes in the relatively new and growing population of adults with congenital heart defects. “Thanks to improved interventions, more and more children born with heart defects are surviving into adulthood,” she says. “We just are learning all the ways the conditions evolve. But since they were so small when their condition was discovered, the patients often don’t even know what their diagnosis was or how it was treated.”

    According to the Centers for Disease Control and Prevention, there is currently no tracking system for older children and adults who started life with heart defects. While there are more than 40 known types of congenital heart defects, according to the Children’s Heart Foundation, there are also dozens that are unique. The difficulty for the older children or adults, says Dr. Fischer, is “that it was the parent who managed the medical interventions.”

    The lucky ones, she adds, can bring the parents with them to appointments. Otherwise, “it becomes detective work, and old records often come on microfiche. We combine that with imaging and monitoring to determine what work was done.”

    Not many cardiologists can bridge both pediatric and adult cardiac arenas, and very few have Dr. Fischer’s unique background. After graduating from the University of Toledo College of Medicine, she spent nine years in post-graduate training and fellowships that ranged from an internal medicine/pediatric residency to pediatric cardiology and then a combined pediatric and adult electrophysiology program. “I don’t know that many other physicians want to do that much training,” she says.

    The breadth gives her unique skills for treating patients, including a 34-year-old who was born with transposition of the great arteries. He had a surgical atrial baffle reroute as a child, but his adult lifestyle led to sustained atrial fibrillation and irreversible muscle damage. “We were able to treat it with a defibrillator,” she says.

    As the population of adults with congenital defects grows, Dr. Fischer is optimistic that there will be more expertise to share with other cardiologists.

    The American Board of Internal Medicine is setting up the first board certification on adult congenital heart disease this year. In the meantime, physicians are com- ing to realize Dr. Fischer’s expertise. “The best part is offering these people help,” she says. “If you have a patient with a history of a hole in the heart and suddenly they feel it racing, take it seriously.”

  • January 07, 2016

    By MedStar Health

    Physicians are spreading the word about the growing local incidence of Chagas disease, a parasitic infection that can damage the heart.
  • January 07, 2016

    By MedStar Health

    Hard on the heels of a major national survey assessing the impact of cardio-oncology care, the American College of Cardiology has appointed Ana Barac, MD, PhD, FACC, chair of a new section devoted to the developing field. Dr. Barac is founder and director of MedStar Heart & Vascular Institute’s cardio-oncology program—the first in the Baltimore-Washington area—and lead author of the survey’s seminal report, “Cardiovascular Health of Patients with Cancer and Cancer Survivors,” which paved the way for the section’s creation.

    Published in the June issue of the Journal of the American College of Cardiology, the survey examined the current state of cardio-oncology services, practices and opinions among cardiology division chiefs and cardiovascular fellowship program training directors, primarily at tertiary academic institutions. Of survey respondents, 70 percent called the cardiovascular implications of cancer treatment “very important,” and more than half agreed that patient care would improve with a cardio-oncology service or staff.

    However, only 27 percent reported having an established, specialized cardio-oncology service with more than one clinician. The absence of national guidelines was frequently cited as a barrier to creating more programs.

    “Despite the significant number of cancer patients experiencing treatment-related cardiovascular issues, we are lacking the proper resources to care for these patients,” says Dr. Barac. “The new cardio-oncology section is dedicated to filling this gap.”

    By providing a forum for cardio-oncology specialists to share best practices and develop educational tools, practice standards and training programs, the new section will work to expand knowledge of the new cancer therapies and their possible adverse effects on the heart. The goal is to improve patient care and outcomes.

    Scientists first discovered the link between cancer treatments and deleterious cardiovascular effects in the late 1960s, giving birth to the origins of cardio-oncology. Today’s cancer therapies can cause heart failure, cardiac dysfunction, arrhythmias, valvular heart disease, accelerated atherosclerosis and pericardial disease.

    In addition to the JACC publication, a summary of survey results and conclusions also appeared in the June 22 posting of ScienceDaily.

  • December 18, 2015

    By MedStar Health

    Armed with techniques learned in Asia and new devices created in the U.S., two specialists at MedStar Washington Hospital Center are giving hope to a subset of chronic total occlusion (CTO) patients whose condition was previously considered untreatable. They include ones who are not good candidates for surgery or have failed medical therapy.

    “We are restoring quality of life to these patients,” says interventional cardiologist Robert Gallino, MD, who is now doing two of these hybrid percutaneous coronary interventions (PCI) a week with great results.

    A recent case, in particular, stands out. Richard Talley, a 70-year-old St. Leonard, Md., man, had coronary artery bypass in 1991 and a mild stroke in 2011. In 2014, he suffered a heart attack. Deepening fatigue meant he had to give up his passion for sailing. “I hated to admit having no energy,” says Talley.

    Talley’s cardiologist performed an angiogram and found the bypass had closed. He sent him to Dr. Gallino after diagnosing CTO. Dr. Gallino had traveled to Asia and Europe to learn special CTO techniques. “The Japanese had special wires and micro catheters that we just didn’t have,” Dr. Gallino says.

    Success rates are now about 90 percent with the U.S. adaptation of overseas techniques and the new tools that produce shorter, more successful openings of CTOs. Dr. Gallino and Nelson Bernardo, MD, started performing these hybrid CTO PCIs about 18 months ago. Only eight U.S. hospitals are doing more than 50 such heart procedures a year, they say.

    Dr. Gallino’s goal was to open Talley’s original blockage. The challenge was twofold: the duration of the CTO—24 years—and the length of the occlusion— approximately 80 mm.

    In this procedure, after failing to cross the CTO from the antegrade approach (1), the retrograde approach (2) through the left anterior descending artery (LAD) was used. The septal perforators from the LAD provided the collateral avenue for the passage of a guide wire into the patent distal RCA segment (3). A hydrophilic guide wire was advanced through a support catheter and used to break the distal cap of the CTO (4). An antegrade balloon was placed into the proximal cap in an attempt to create a membrane with the retrograde wire. This wire was advanced, retrograde, up the total occlusion into the guiding catheter engaged at the ostium of the RCA. The support catheter was then advanced into the guiding catheter establishing access. This allowed the advancement of a 350-cm guide wire from the left coronary guide through the occlusion and into the RCA guiding catheter. The exteriorized guide wire was then used for antegrade advancement of balloon catheters and coronary stents for definitive treatment of the RCA CTO.

    “The technique provides an additional opportunity for patients who would otherwise be relegated to medical therapy,” says Dr. Bernado.

    “Some of these patients, like Mr. Talley, talk about how miserable they were before and how great they feel now,” says Dr. Gallino. Talley agrees. ”I went from a small six-cylinder to a big V-8 engine! I felt better almost immediately and haven’t stopped since.”

    For more information, please email Dr. Gallino or Dr. Bernardo

    revascularization-cvp

    1) Antegrade approach
    2) Retrograde approach
    3) Retrograde guide wire
    4) Breaking through retrograde distal cap

    chronic-total-occlusion-1

    Top right: Right coronary artery before with a chronic total occlusion (CTO) soon after its origin

    stent-inflated-2

     Middle: Stent inflated in the right coronary artery

    after-CTO-3

    Bottom: Right coronary artery after CTO percutaneous coronary intervention (PCI)

     

  • December 17, 2015

    By MedStar Health

    Clinical Trial Will Study Novel Stem Cells in Cardiac Patients

    When stem cell research targeted to cardiovascular disease first made headlines almost two decades ago, many speculated it would create a new era of medical therapy for acute myocardial infarction and heart failure patients. However, despite encouraging preclinical study results and enthusiasm emanating from initial small clinical trials, overviews of the results of all published major randomized trials conducted through 2012 were disappointing.

    “There was no substantial improvement in clinical end points,” says Stephen Epstein, MD, head of translational research and vascular biology research at MedStar Heart & Vascular Institute (MHVI).

    The challenges forced new approaches to cardiac stem cell therapy, which are reflected in a new clinical trial getting underway at MHVI this winter. The trial will determine the effects of intravenous administration of a novel stem cell in patients with chronic non-ischemic cardiomyopathy. Dr. Epstein, an internationally recognized authority on stem cell therapeutics targeted to cardiovascular disease, says, “These new strategies have reinvigorated research in stem cell therapies, particularly for cardiac patients.”

    To determine why the first stem cell trials were not providing the anticipated therapeutic potential, “all variables, such as which stem cells were used, and how they were developed and administered, were open to consideration,” says Dr. Epstein.

    A key issue was the use of autologous stem cells in all previous studies. Studies demonstrated these “old” stem cells are functionally defective when compared to stem cells obtained from young healthy individuals. So harvesting a healthy young donor’s bone marrow and growing the resident stem cells might produce more robust cells.

    However, giving a patient allogenic stem cells raised an important issue: whether such cells will be rejected by an immune response. But research showed mesenchymal stem cells (MSCs), a type of “adult” stem cell, “have been designed by nature to be stealth bombers,” explains
    Dr. Epstein. “They express molecules on their surface that prevent the body from recognizing the cells as ‘foreign,’ so the patient does not reject the donated MSCs.”

    To further explore and refine potential stem cell cardiovascular therapies, MHVI expanded the translational research team to include Michael Lipinski, MD, PhD, an expert in molecular biology and scientific lead for preclinical research at the MedStar Cardiovascular Research Network, and Dror Luger, PhD, an expert in immunology and inflammatory responses. “By bringing together these diverse areas of expertise, we forged a team with the potential to produce research that could lead to important breakthroughs in understanding how stem cells might work and thereby provide more successful treatment of patients with cardiac disease,” says Dr. Epstein.

    CardioCell, a San Diego-based stem cell company focused on stem cell therapy for cardiovascular disease, found that MSCs grew faster and showed improved function when cultured in a reduced oxygen environment. “Stem cells typically grow in the body, in bone marrow and other tissues, in a low oxygen environment—only five percent oxygen, as opposed to room air, which is about 20 percent,” explains Dr. Lipinski. “All previous stem cell trials used cells exposed to, and grown under, room air oxygen conditions.”

    Using CardioCell’s low oxygen-grown MSCs, the MHVI scientists demonstrated biologically important effects occurred, even when the MSCs were administered intravenously. This mode of administration was previously rejected by scientists who thought cells would be trapped in the first capillary bed they traversed—the lungs—and never reach the heart.

    However, the MHVI team demonstrated a small percentage of these IV administered MSCs did reach the heart, where they could exert beneficial effects. The cells seek out inflamed cardiac tissue after a heart attack because “they upregulate receptors that allow them to be attracted to and penetrate inflamed tissue in high numbers,” says Dr. Luger.

    The investigators also found the cells residing in other tissues could provide other benefits. “It has been shown that a heart attack activates the immune and inflammatory systems, including those in the spleen,” explains Dr. Luger. “The systemic anti-inflammatory effects produced by MSCs in the spleen, lungs and other tissues caused by the molecules secreted by the MSCs could exert positive effects as well.” Dr. Epstein added that “such anti-inflammatory effects could also benefit the excessive inflammatory activities that exist in many heart failure patients.”

    For the clinical heart failure trial, MHVI is partnering with CardioCell, which will grow and provide stem cells already used in Phase I and 2a clinical trials and approved by the Food and Drug Administration.

    As an extension of their stem cell work, the MHVI investigators are building on the fact that any beneficial effect of adult stem cells will not derive from their transformation into heart muscle, but rather from the molecules they secrete; these, in turn, stimulate pathways favoring tissue healing. The team is investigating the use of liposomes as therapeutic delivery vehicles for these secreted products, which include those with anti-inflammatory and angiogenesis activities.

    If successful, using MSCs for anti-inflammatory and immune-modulatory effects could have implications for many different diseases, including arthritis and autoimmune diseases like rheumatoid arthritis. Dr. Epstein cautions that a great deal of research is yet to be done before such applications can be routinely used to treat patients with these conditions. For now, they hope the current studies in heart failure patients will demonstrate effectiveness. “If so,” Dr. Epstein says, “it changes the whole playing field for stem cells.”

    stem-cells-graphic-mwhc-mhvi

    Pathways contributing to development and progression of dilated CM that also might be targeted by paracrine factors derived from stem cells.