MedStar Health Blog

Good skin health not only can increase the vibrance of our face, limit wrinkling, and reduce skin cancer risk, but it also can benefit our immune system. As our largest organ, the skin serves as the brick wall between your body and the outside world. When skin is dry or poorly nourished, it doesn’t do its job as well, which can cause skin conditions such as:

• Bumps
• Itchy skin
• Rashes
• Reactive skin

Left untreated, these conditions can lead to skin infections. People can maintain healthy skin by following several different lifestyle modifications, ranging from the use of certain skin care products to following certain diets. Let’s discuss my favorite recommendations.

1. Get a Good Night's Sleep

A good night’s sleep benefits many aspects of our health, including the skin. If you’ve ever had to pull an all-nighter for school or work, you’ve probably noticed your skin appears dull the next day. This is because when we rest, our body rebalances fluids, which restores moisture and removes excess water from our body. This helps limit the effects of sleep deprivation on your appearance, such as under-eye circles and puffy bags under your eyes. For folks with autoimmune conditions that affect the skin, such as lupus, poor sleep can also trigger flares.

Aim to get seven to nine hours of sleep each night. Beyond your skin, sleep deprivation and deficiency is associated with serious health implications, including:

• Depression
• Increased heart failure risk
• Type 2 diabetes

2. Keep Your Skin Hydrated

As the skin is a barrier against infection, it’s important to keep your skin hydrated. If you allow your skin to become dry, it can become cracked—which could allow the bacteria that live on your skin to get inside and cause an infection. Furthermore, moisture affects the appearance of your skin. Without moisture, the skin’s natural processes, such as exfoliation, or the removal of dead cells on the skin’s surface, can’t occur naturally. As a result, skin typically will look less radiant and healthy.

Make sure to use an emollient, such as a lotion or cream, on a regular basis. Speak to your dermatologist to discover which moisturizers are best for you.

3. Use the Right Sunscreen

Regularly using sunscreen is important for your health, even if you typically don’t experience sunburns without it. This is because sunscreen helps protect us from exposure to ultraviolet (UV) radiation, which can have implications such as:

• Skin cancer: UV radiation is arguably the leading skin cancer-causing agent in our environment. We have strong evidence that the three main types of skin cancer—basal cell carcinoma, squamous cell carcinoma, and melanoma—are caused, in part, by too much exposure to the UV rays in sunlight. Remember, there is no such thing as a “healthy tan”. A tan is the body’s way of trying to protect the DNA in skin cells from radiation and damage which might lead to skin cancer.
• Aging skin: UV radiation speeds of the aging of skin, as it destroys collagen, the most abundant protein in the body, and connective tissue beneath the top layer of the skin. This can cause wrinkles, brown spots, and sagging and draping of the skin due to loss of skin elasticity.
• Mottled or uneven pigmentation: Folks with deeper skin tones benefit from daily sunscreen and photoprotection. Certain pigmentary disorders are more common in brown or deeply pigmented skin types, such as melasma, or post-inflammatory hyperpigmentation.

I recommend using a sunscreen that has a sun protection factor (SPF) of 30 or higher every day. Even if you’re only spending 15 minutes outside to and from your walk to work every day, using sunscreen can go a long way in preserving your skin health.

4. Use Mild, Gentle Cleansers

It’s important to use mild, gentle cleansers, ideally one that is fragrance-free. These cleansers are less damaging to the skin compared to most standard soaps, which can strip skin of its natural moisture, causing irritation and dryness that can lead to infection, as well as more dull-looking skin.

Appropriate cleansers come in bar, liquid, foaming, or fluid formulations which may be appropriate for your skin type, and don’t have to cost a lot of money to be effective.

5. Consume a Healthy Diet

Foods with a high glycemic index—a ranking of carbohydrates in foods according to how they affect blood sugar levels—can contribute to skin conditions such as acne and bullous pemphigoid, an autoimmune disease that causes skin blistering. Common foods with a high glycemic index include doughnuts, french fries, and white rice. Moreover, a diet in which you consume healthy amounts of vitamins, minerals, and essential fatty acids can help you avoid certain rashes, as some are specific to certain vitamin and mineral deficiencies or the over-consumption of them.

I typically suggest that patients avoid highly processed foods and eat plenty of fruits, vegetables, and all-natural foods that were available to our great-grandparents—before processed foods became so popular.

Additionally, some popular weight loss trends have resulted in rashes. One such trend right now is the ketogenic (keto) diet, which emphasizes foods packed with protein and suggests avoiding the consumption of carbohydrates. Some individuals strictly adhering to this diet have developed a rash called prurigo pigmentosa, which resolves when some carbohydrates are reintroduced into the diet. If you’ve been following the keto diet and experience any abnormal rashes, make sure to speak to your doctor.

How Genetics Impact Skin Health

Like most other things in life, genetics can affect your skin’s health, such as your skin cancer risk from the overexposure of UV radiation from the sun and other skin diseases. Skin appearance, such as the size of your pores and developing acne, also can be due to genetics. However, just because you have a genetic predisposition to certain skin conditions doesn’t mean you’re certain to develop them—especially if you take good care of your skin.

Maintaining healthy skin not only helps us avoid infection, but it also makes us look and feel better. Make sure to incorporate these tips into your life to keep your skin as healthy as possible.

Head and neck cancers appear on visible parts of the body—so, naturally, people fear they might not look like themselves following cancer treatment. However, with the surgical techniques we use today, people often experience very little scarring after their cancer is removed.

The most common type of head and neck cancer is called squamous cell carcinoma, which accounts for about 90 percent of all cases and can affect the:

• Back of the throat
• Inner surface of the cheeks
• Jaw bones
• Palate
• Saliva glands
• Tongue
• Voice box

Former Buffalo Bills quarterback Jim Kelly had a public fight against head and neck cancer, specifically cancer in his upper jaw bone, or maxilla. After his cancer recurred after receiving chemotherapy and radiation therapy, Kelly underwent surgery to remove his upper jaw bone. His upper jaw was reconstructed using a fibula free flap, which is when a piece of bone and tissue from the fibula supplied by an artery and vein is used to replace the missing upper jaw bone. The artery and vein from the flap are connected to an artery and vein in the neck, providing the tissue with its own blood supply. After receiving dental implants months later to replace teeth that were removed during surgery, Kelly now talks and eats normally, looks about the same as he did before surgery, and remains cancer-free.

LISTEN: Dr. Giurintano discusses reconstructive surgery for head and neck cancer in the Medical Intel podcast.

How Reconstructive Surgery for Head and Neck Cancer Works

Many years ago, we could remove patients’ head and neck cancers, but we couldn’t reconstruct the areas where cancer was removed, which often led to noticeable deformities or scars. However, today’s techniques allow patients to experience much less cosmetic and functional deformity.

Free-flap surgery—when we transfer tissue from one part of the body to another—is the most common technique we use. During a free-flap surgery, we remove the cancer and reconstruct the resulting defect at the same time, with one surgeon removing the cancer and the other harvesting and placing the flap. The free flap surgeon uses a microscope to sew an artery and vein from the flap to an artery and vein in the neck, which provides the transplanted tissue with its own blood supply. This is important because many people later receive radiation therapy as part of their treatment, and without a robust, healthy blood supply, non-vascularized tissue dies from radiation therapy. Surgery typically takes about six to 10 hours, a far cry from the 24 hours it took 20 to 30 years ago.

Who Is a Candidate?

To determine if an individual with head and neck cancer is an ideal candidate for a free flap, we perform tests such as angiography, which examines blood vessels through an X-ray to ensure that they are healthy enough to support a free flap. This is especially important when we do a fibula flap, as we have to ensure that a person has the standard three blood vessels that supply blood to the leg. In rare cases, patients do not have three vessels supplying the foot, so we have to consider alternative options, such as the rib or scapula (shoulder blade).

Additionally, we consider a patient’s’ lifestyle. For example, if a patient is a pianist, we prefer to remove skin from their leg or hips rather than their forearms or wrists, as it could interfere with their ability to play.

What to Expect During Recovery

Following free-flap surgery, patients typically spend two days in the intensive care unit, as we closely monitor their blood vessels to ensure clots do not form. Then patients usually spend three to five days in a regular inpatient setting, where they can also receive physical therapy to help them maintain or restore their strength. Once patients return home, it normally takes them another couple of weeks for a full recovery, which includes rehabilitation of swallowing, speaking, and other normal activities.

Depending on the severity of the case, some patients return home and require minimal follow-up care, while others occasionally need feeding tubes or tracheostomy tubes, which are inserted into the neck to provide an air passage to help people breathe when the usual route for breathing is obstructed or impaired due to too much swelling. Additionally, some patients can experience difficulty swallowing. Because we are concerned that they might accidentally aspirate their foods, we help facilitate nutrition while they’re recovering by placing a tube into the stomach for about six to eight weeks or until their neck has fully recovered.

Expert Care at MedStar Washington Hospital Center

We use a team approach at MedStar Washington Hospital Center to treat head and neck cancer, which includes surgeons who remove the cancer, reconstructive surgeons who repair the affected skin, and facial plastic surgeons who can perform additional cosmetic surgery. We also work with colleagues in the departments of radiation oncology and medical oncology, as many cases of head and neck cancer require radiation therapy or chemotherapy.

We have regular meetings in which surgeons, medical oncologists, radiation oncologists, speech pathologists, and radiologists meet to discuss new cancer patients and patients who recently had their cancers treated. During this meeting, we bring all of our expertise together to stage each patient’s cancer and determine the best treatment plan for them.

Reconstructive surgery for head and neck cancers has come a long way over the years. Patients now can not only treat their cancer but also experience very few changes to their appearance and daily lives.

After a lifetime of frequent relocations, Laura Boger, MD, has found a home in the nation’s capital as a dermatologist at MedStar Washington Hospital Center.

Dr. Boger cites the Hospital Center’s diverse patient population, comprehensive and high quality of care, and the ability to collaborate with multiple other specialties helped make the decision to come to Washington easy. As an instructor at Georgetown University School of Medicine, “I have the opportunity to teach students and residents,” she adds.

Although Dr. Boger counts a number of physicians in her family, it was only during her self-described “wandering” post-graduate years that she chose medicine as a career.

She received her medical degree from the University of Tennessee Health Science Center in Memphis, and stayed there for residency training in both internal medicine and dermatology. Dr. Boger is also board-certified in both disciplines.

Evidence-Based Approach to Treatment

In her practice, Dr. Boger applies evidence-based treatments for dermatological diseases, with a special interest in complex medical dermatology, psoriasis, autoimmune blistering diseases, general autoimmune disease, rheumatology dermatology, and inpatient hospital dermatology consultations.

"Dermatology spans a variety of conditions that can have a major effect on people’s lives, either by themselves or as a symptom of something else,” Dr. Boger says. “The field’s diagnostic and procedural aspects enable me to work with patients of all ages, to pinpoint the cause of their condition, and create a management plan that works for them.”

Another advantage of joining MedStar, Dr. Boger adds, is the opportunity to explore Washington’s parks, museums and attractions with her husband and young daughter, and to reconnect with family members in the area. Summer will be a great time to get out some more, she adds, but hopes everyone takes care to safeguard themselves from the sun.

Sunscreen Misconception

“There’s a misperception among many patients with skin of color that they don’t need sunscreen,” Dr. Boger says. “In fact, everyone needs some degree of protection to reduce the risk of skin cancer. And if something unusual appears on the skin, don’t put off getting it checked out.”

There are a number of symptoms that might be warning signs of a heart attack—from radiating chest pain to something as subtle as dizziness or lightheadedness. The symptoms can even vary from men to women, too.

Women often have heart attack symptoms that are different from men’s symptoms, and women often overlook these symptoms because they don’t want to overreact. A patient can be experiencing alarming upper belly pain, but they don’t want to call an ambulance, go to the emergency room, and then find out their pain was only indigestion.

Don’t ignore your body. Know what signs of a heart attack women should watch for and whether you’re at risk for a heart attack so you can get help fast if you need it.

Related reading: Why do more women than men die after heart attacks?

What Signs Should I Watch for?

Women are more likely to have a silent heart attack, or one that doesn’t show any apparent symptoms. They’re also more likely to die after their first heart attack because they don’t want to overreact to symptoms. Women rarely feel the classic crushing pain in the chest that appears for men who have heart attacks. Instead, women’s symptoms often are more subtle and may include:

• Chest discomfort or fullness
• Blackouts or fainting
• Breathlessness during activities or waking up breathless at night
• Chronic fatigue after routine activities
• Dizziness that can indicate irregular heartbeats, or arrhythmias
• Swelling, particularly of the lower legs and ankles
• Palpitations, rapid heartbeats that may cause pain or difficulty breathing
• Nausea or vomiting, unrelated to diet, indigestion, or abdominal pain
• Sweating

Some patients say they feel an impending sense of doom. They feel as if they will die if they don’t seek help.

In women with diabetes, the symptoms are a bit different. They can experience chest pain when they’re going down the stairs to laundry or going up the stairs to put their kids to bed. If the pain creeps up on you and then gradually dissipates, this usually is an indication of coronary artery disease. You most likely have a blockage in a blood vessel that supplies blood to the heart that needs to be taken care of.

Patients also can feel pain in the middle of their chest that travels to their back. Some people even have chest pain on their right side, away from the heart. If your symptoms aren’t going away and they’re alarming you, don’t take the chance. Call 9-1-1 and take that ambulance ride.

Heart Attack Risk Factors for Women

It’s even more important to seek medical help for possible symptoms of a heart attack if you have risk factors for heart disease, such as:

• A family history of heart disease
• Diabetes
• High blood pressure (hypertension)
• High cholesterol (hypercholesterolemia)

Diabetes can lead to serious cardiovascular issues, particularly in women. A woman’s risk for heart disease increases after menopause because estrogen levels decline. Before menopause, estrogen can protect against some of the problems related to high cholesterol, a common factor in heart disease.

Lifestyle choices such as smoking, an unhealthy diet, and not exercising can lead to heart disease. Women should have their blood pressure, cholesterol, glucose, and body mass index checked by their doctor. Monitoring those numbers can help you stay healthy. They should also learn about their family history and discuss all these issues with a doctor.

We know that coronary artery disease can manifest suddenly and become a heart attack. Women should take these symptoms seriously and not take the chance. They should seek medical help. It’s better to be safe than sorry.