At the end of May 2021, Valisure released a report that they found benzene, a known carcinogen that can cause leukemia, in a number of sunscreens and after-sun care products from major brands.  Valisure is an independent lab based in Connecticut that does consumer watchdog testing for many medications.

The Valisure reports of which sunscreens contain benzene:

• Valisure Benzene Report
• Valisure Safe List

Summit Dermatology organized lists:

Most of the products Valisure tested did not contain benzene, so we at Summit Dermatology wanted to organize the lists published by the testing company so it would be easy to identify if your sunscreen and after-sun care products are safe.  The FDA has not yet forced any product recalls based on this testing, so many of these products are still on the shelves.  Below are attachments for three lists we put together: (1) the list of products with high levels of benzene, (2) the list of products with detectible but low levels of benzene, and (3) the list of products which did not have any detectible levels of benzene and are considered safe from this particular carcinogen:

• High Benzene Levels
• Low Benzene Levels
• Safe List (no detectible benzene)

General recommendations:

In general, sunscreens that were found to have high levels of benzene were almost all sprays.  Also, the majority of these were chemical sunscreens rather than mineral sunblock (zinc oxide or titanium dioxide). Mineral sunblock is considered the safest type of sunscreen, especially for young children.  Using lotion sunscreen that you have to rub in by hand is recommended over a spray sunscreen, and the results of the Valisure benzene testing are another reason to choose lotion sunscreen rather than a spray.  Sunscreen spray typically causes uneven skin surface coverage, which can leave areas of the skin between spray droplets inadequately protected from the sun unless the product is rubbed in by hand. Sunscreen lotion is effective at reducing the harmful effects of the sun’s ultraviolet radiation, which can lead to photoaging of the skin and can increase your risk for skin cancer.

What is benzene, anyway?

Benzene is an organic solvent used for oil extraction from seeds and nuts, used for manufacturing pharmaceuticals, and found in the air from coal, oil, and gasoline emissions or from burning wood or a wax candle.  Benzene is highly volatile, meaning that most of it would evaporate very quickly from the surface of the skin after sunscreen is applied. It is unknown if any of the benzene found in certain sunscreens is even absorbed through the skin into the bloodstream.

Is sunscreen safe?

Benzene is not an ingredient in sunscreens. The fact that the Valisure tests found trace amounts of benzene present in certain batches of sunscreen is because it is likely a contaminant. Manufacturing mechanisms are likely in place to avoid this contaminant in the future.  The bottom line is that the health risks of trace levels of contaminants in sunscreens like benzene are unknown and likely very low, while the risk of skin cancer due to prolonged and/or intense sun exposure without protection from sunscreen is well studied and quite high.  Not only are sunscreens considered very safe, but they are an important part of protecting yourself from the harmful ultraviolet radiation of the sun.

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Melanoma is a very serious form of skin cancer because it can spread to other parts of the body and cause death. It is very important to find melanoma early and have it removed so that the chance for spread is very low. Performing skin self exams will help you catch it quicker and get it removed. 

You can remember what to look for with a mnemonic called the ABCDEs of melanoma was created:

• A is for Asymmetry. Draw a pretend line down the middle of a mole. If one side of the skin lesion looks different than the other side, then it’s asymmetrical.
• B is for Border. An irregular, scalloped, or ill-defined (fuzzy) border can be concerning.
• C is for Color. We like a uniform or even. color. Light is better. If there is a very dark brown or black spot, or if there are areas of white, red, or blue in a brown lesion, this can be concerning.
• D is for Diameter. A spot larger than a pencil eraser (6mm or ¼ of an inch) should be examined closely.
• E is for Evolution. If you have a spot that’s changing – in size, shape or color, this can be a warning sign.

Any of these findings may indicate that the spot is not a benign mole but rather an early melanoma, and it should be brought to the attention of a dermatologist right away. Your dermatologist will perform a careful skin examination and may perform a biopsy to remove it to test for melanoma. After numbing the skin, the spot will be removed and sent to a specialized pathologist for the final diagnosis. A biopsy is a very quick procedure that is easy to heal from.  If the dermatopathologist determines that the spot is a melanoma, your dermatologist will help you decide on the most appropriate treatment.

At Summit Dermatology, we take melanoma very seriously and are careful to always provide correct diagnosis and treatment as early as possible.

For more information about the ABCDEs of melanoma, visit the AAD website:

https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/symptoms

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Botox Cosmetic ® (onabotulinumtoxinA) is the most widely recognized brand-name product among several available injectable medications used for reduction of wrinkles.  Botox is most often used between the eyebrows to reduce the effect of a scowl in forming wrinkles in this area.  Other common areas of use are for wrinkles across the forehead, squint lines at the outside corners of the eyes (crow’s feet), and scrunch lines on the sides of the nose (bunny lines).

Botox works by blocking the signal from a nerve to the muscle which causes the muscle to contract and wrinkle or pinch the skin. This paralyses the treated muscle. This action is irreversible once in place and its effect gradually wears off over time.

The strongest effect of Botox lasts for at least 2 months.  Most people continue to have benefit in reduction in the formation of wrinkles for 4-6 months after Botox injection.  Some people who repeat Botox injection regularly over several years or more report slightly longer duration of benefit.  It is common to repeat Botox injection every 4-6 months depending on budget and treatment goals.  People who have regular Botox injections over many years have less of an increase of the formation of fixed, resting wrinkles that occur during aging compared to peers who do not have routine Botox injections.  In addition to sun protection, moisturizing, a topical retinoid, or topical antioxidants, Botox is often an important part of someone’s “anti-aging” skin regimen for the face.

Interestingly, some people who have regular Botox injection may require a slightly lower dose over time due to slight weakening of the muscles from lack of use. This means less medicine is required for similar cosmetic benefit for some people with repeated use.

Some people have stronger muscles of facial expression and may require larger doses than other people. For the area between the eyebrows, most men often require a slightly higher dose compared to most women for a similar desired effect.

Since Botox is not immediately reversible, it is important that you only go to someone you can trust for your injections. At Summit Dermatology, only our Board-Certified Dermatologists do Botox injections. We do not have any nurse injectors or aestheticians in our clinic. Call us for a consultation if you are interested in the benefits of Botox Cosmetic ®.

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Most people think acne is something that you can get on the face, but a lot of us know that is not the only place. Many of us have some degree of acne on our neck, shoulders, chest, or back.  If your acne is severe enough in these areas to leave behind scars or long-lasting discoloration, please come see us at Summit Dermatology.  We can help!  When body acne is this bad, we often have to use prescription medications to help keep it clear.

A lot of us have acne on the back, but it may not be bad enough to require prescription medication. Some of us may be using medication for back acne but also want to make sure we are doing everything else we can to keep it clear.  If you have been wondering how to get rid of back acne, we have some helpful tips for you.

Consider adjusting your daily routine.

• Avoid any products that can clog pores (ointments or oils)
• Wear more loose fitting clothing over the affected areas
• Shower after workouts or sports to remove sunscreen and sweat
• Wash sheets regularly
• Use a loofah or body scrub to exfoliate weekly

You may also want to consider using a body wash that contains ingredients that help to treat back acne.

• Salicylic acid can be helpful as an exfoliating ingredient.
  • Choose this type of wash if you have a lot of whiteheads and blackheads
  • Neutrogena Body Clear Body Wash is a great option (also available in grapefruit)
  • CeraVe SA Body Wash for Rough and Bumpy Skin is another good option.
• Benzoyl peroxide can be helpful for more inflammatory acne
• Acne Free Oil-Free Acne Cleanser is our first choice
  • Largest quantity at the best price
  • 5% benzoyl peroxide with ceramides is gentler on the skin
• PanOxyl Acne Creamy Wash is a slightly stronger option with 4% benzoyl peroxide
• CeraVe has a new Acne Foaming Cream Cleanser that has 4% benzoyl peroxide. This comes in a smaller quantity and may be more appropriate as a face wash than a body wash
• We recommend leaving the medicated wash on the skin for longer than a minute before rinsing

Sometimes adjusting your daily routine is not enough. In these cases, we recommend looking into medications for your body acne treatment.

• The over-the-counter retinoid is Differin Gel (adapalene 0.1%)
• Prescription topical retinoids (tretinoin or tazarotene) may be used for more severe back acne, but often these medications are dispensed in small amounts that can be difficult to use on the back. Fabior Foam is a strong prescription retinoid (tazarotene 0.1%) that may be easier to apply
• Prescription topical antibiotics which are available as solutions, lotions, or gels
• We can also use oral medications for more severe cases of back acne

Back Acne & Body Acne Treatment

We hope many of the above recommendations help. However, if you’re tired of dealing with back acne or have been unsuccessful in keeping it clear, let the dermatologists at Summit Dermatology in Colorado Springs and Monument, CO help. Call us to schedule an appointment for body acne treatment today.

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Many people often wonder, “what does skin cancer look like?”  It can be difficult to know when to be concerned about a new spot on the skin. As we get older, new spots appear more and more over time. The vast majority of these are harmless, however it is easy to miss a new skin cancer among the benign skin spots. This blog post is to help point out some of the warning signs for a new skin cancer and some of the typical appearances of the three main types of skin cancer.

Basal cell carcinoma

Basal cell carcinoma (BCC) is the most common type of skin cancer.  This often appears in areas of our skin that have been exposed to sun on a regular basis over time, such as the face, scalp, neck, or arms.  This type of skin cancer has different growth forms, the two most common of which are called superficial and nodular.

A superficial BCC will often appear as a flat pink patch on the skin surface that might be slightly shiny compared to nearby normal skin. You may see small blood vessels in this patch and its edges may be slightly raised. Its edges are often blurred and blend in with surrounding normal skin. This may be slightly itchy but might also be something you don’t feel at all.

A nodular BCC often starts to grow as a small pink bump. Initially this bump is usually smooth, but as it grows over time, it can get slightly flaky.  With continued enlargement, a nodular BCC will start to form a sore in the center of the punk bump, which is often described as “never healing” or “bleeding on its own.”  This central sore (ulceration) will deepen and cause the edges of the growing cancer to look “rolled” like the crust of a pizza.

Squamous cell carcinoma

Squamous cell carcinoma (SCC) is slightly less common than BCC. This type of cancer can arise on its own or from a precursor growth called an actinic keratosis (AK). AKs tend to be flat light pink spots with round scale light sandpaper. These might initially be confused for rash or dry skin but just don’t heal or resolve.

Certain types of SCC may just be a slowly growing pink area with scale, but what is often different from an AK is it will start to feel raised or thickened rather than completely flat.  The redness can be sore or itchy, and an SCC can start to bleed spontaneously and become crusty.

Other types of SCC can appear and grow very suddenly and dramatically, often with a dome shape or volcano shape due to a central crusty depression or crater.  These tend to bleed easily and have abundant dry scale on the surface. Redness is a prominent feature compared to surrounding normal skin.

Melanoma

Melanoma is the most serious of the common types of skin cancer, making early diagnosis especially important. Although there are some uncommon cases that have different appearances, most melanomas produce some pigment and create a brown spot on the skin. This brown spot may be new, growing, changing, irregular in shape or color, or particularly darkly pigmented.

There is a mnemonic called the “ABCDE”s of melanoma meant to make it easier to remember some of the warning signs when looking at pigmented spots on the skin:

1. Asymmetry: one half is unlike the other half
2. Border: an irregular, scalloped, or poorly defined border
3. Color: variations of tan, brown, black, and sometimes white, red, or blue
4. Diameter: melanomas are usually greater than 6mm (size of a pencil eraser)
5. Evolving: anything that looks like a mole but is changing while others aren’t

The cancer.org website has some nice example images of these three types of skin cancer as well as some benign skin growths that can look similar to the skin cancers: skin cancer examples. 

There are other types of skin cancer than the three listed above. If you have any questions or concerns about what you are seeing on your skin, please call us at Summit Dermatology in Colorado Springs and Monument, CO to make an appointment with one of our board-certified dermatologists. 

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January 8th is National Winter Skin Relief Day.  In Colorado, we face very dry winter conditions that can be hard on our skin.  When the temperature drops, the air in our homes becomes even more dry as we run our furnace to stay warm. National Winter Skin Relief Day is a reminder for us to pay attention to what we can do to protect our skin so we can avoid dry skin problems.

At Summit Dermatology, we often see patients for rashes, itching, and other skin conditions that are caused by or made worse by the dry winter conditions in Colorado.  In this post, I will share some of our recommendations for how to take care of your dry skin this winter. These recommendations are summarized in our dry skin care instructions handout, which is available on our website and in our clinic.

When bathing or showering, we recommend using mild and moisturizing cleansers such as CeraVe Hydrating Cleanser or Dove For Sensitive Skin.  It is important to avoid harsh soaps or soaps with perfumes such as Irish Spring. Antibiotic soaps such as Dial can greatly worsen dry skin.  It is important to avoid the temptation to take a long, hot shower. The hot water strips the skin of natural oils (ceramides) that help lock moisture in the skin, and the heat also increases inflammation.  Avoid scrubbing or manually exfoliating. Pat dry with a towel rather than rubbing, then quickly apply a moisturizing ointment or cream to restore and retain moisture in the skin while the bathroom door is closed to keep humidity in the air.

When your skin is wet, an ointment will best trap the moisture in the skin.  This is often a recommendation we make for children with eczema to help keep dry skin moisturized after bathing.  If you have dry, cracked skin, an ointment or a thick cream with petrolatum will help to replenish moisture in the skin.  Hyaluronic acid can be very hydrating, and ceramides are an important ingredient in a highly effective moisturizer. Examples of moisturizers with ceramides include CeraVe and Cetaphil Restoraderm.

To help prevent dry skin in harsh winter conditions, it is recommended to wear layers of clothing to keep warm.  The innermost layer of clothing touching the skin should be a soft natural material like cotton or flannel. Synthetic fabrics can cause more irritation on the skin.

At night, a cool mist humidifier can help hydrate dry skin.  This can provide a lot of relief. Having a humidifier on your furnace can also greatly help if available.

Sometimes dry skin can become very inflamed and cause an itchy or painful rash.  This may be the time to come to our clinic for evaluation, as you may benefit from a topical anti-inflammatory prescription medication.  However, this type of treatment only works well when the skin is well taken care of and moisturized frequently. Let this National Winter Skin Relief Day be a reminder to take care of your skin this winter.  Print our dry skin care instructions handout and call us if you need our help to heal your skin this winter.

Andrew Johnson, MD

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