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Checking your skin – The earlier the better. –


woman checking skin in mirror

Skin cancer, and the potential for it, is the only cancer that is visible – you can see it from the moment it appears.
The Charles SLBG Foundation has teamed up with First Derm to provide their service for the early detection of skin cancer. Utilising the funds raised, including those donated by so many of Charles’ friends,the charity will fund the first 5,000 requests submitted using this page.

First Derm can check any skin concern within hours and give you peace of mind on the move, or from the comfort of your own home. Securely upload your symptoms and pictures with complete anonymity and data protection. A dermatologist, based in the UK, will respond within 24 hours with the most likely condition and what next steps to take.

 

Aims of the Foundation:

  • To provide a free assessment service through First Derm for the early detection of skin cancer to young people.

 

Charles’s Story

We first found out Charles had cancer at the end of November 2011 when the results of a biopsy, from a mole under his arm, came back as cancerous. Shortly afterwards we found out that it had spread far beyond that mole and was considered Stage 4 Metastatic Melanoma; one of the fastest growing and hardest cancers to beat at this point. However if caught early, success rates are high.
Charles had been to see a doctor several times in the months prior and, without a trained eye, the doctor repeatedly told Charles that it was fine and there was nothing to worry about. It is hard to say what might have been if we had caught the disease earlier but with something like this, time is of the essence.

We started off with a vision for the Foundation to offer mobile walk-in dermatology clinics to visit universities. The aim being to give quick and effective diagnosis of moles and skin complaints in the hope of detecting skin cancers (especially Melanoma) in the earliest stage.

This proved to be hugely costly and challenging to create and manage so we looked for an alternative approach. After a few false starts, we received an introduction to Alexander Börve’s company First Derm, who we are now working with to provide a simple, easily accessed, service.

First Derm breaks down the barriers between you and quick, trustworthy dermatology. With their app or website they connect you to a dermatologist in under 24 hours. First Derm were also already running a screening service in the UK and so it was a simple decision  for us.

 

First Derm’s Story

The demands on public healthcare increase as populations age. At the same time, higher quality care can be made possible through medical and technological innovation with smartphones.

Mobile solutions, called “mHealth”, bring about new possibilities for the individual to access healthcare services. In the US and EU, mHeath is beginning to change the healthcare landscape for the better. First Derm’s accessible, safe, and effective platform is at the forefront of the mHealth revolution.

First Derms’ board-certified dermatologists give accurate information regarding the possible identity of your problem, the possible treatment options to consider, and if or when you should see your doctor in person. The service should not be considered as a substitute to your in-person doctor visit, but rather as a high quality information service from experts, which serves as a complement to existing healthcare information and healthcare providers. Anyone with an internet connection and a camera can use their service! With a web portal and iPhone app, First Derm acts as your mobile online dermatologist. They have had over 15,000 cases submitted from all over the world from countries such as Sweden, Chile, China, Australia, and Ghana. Their youngest users have been 3 days old and the oldest at 93 years old. Their dermatologists are ready to give anyone the advice they need about their skin.

 

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Exfoliants and Toners: 4 Reasons to Be Skeptical


Different skin experts recommend different skincare regimens. Curious about some recommended daily exfoliant and toners, which I have noticed you have not recommended. Could you comment on what toner is supposed to do and why you don’t list it? Also exfoliant vs antioxidant. Thank you.

Glad you asked this but… sigh. 🙂  Toners are one of my pet skin peeves because they have such a vague function. I love exfoliants, especially for oilier, thicker skin, but lately the trend has been to over exfoliate.

Patients often forget that any retinoid, or alpha or beta hydroxy acid, will already be chemically exfoliating. That’s, for most, usually enough, but if more is desired, a gentle exfoliant 1-2 times a week is plenty. Over exfoliation is just irritating to the skin, and leaves it dry due to increased TEWL (trans-epidermal water loss).

Toners: 4 reasons to be skeptical:

  1. What are they toning?  I think of the word “tone” as that “snap back” effect (elasticity), good collagen (firm), and texture (usually pore size and acne). Skin already has it’s own tone and we’re just trying to improve it, right? So then I think… there’s nothing really in any toner I’ve seen that would help the above.
  2. Skin pH. When they talk about restoring skin pH, studies have shown that skin corrects it’s own pH quite quickly after a disruption. pH is just a measurement of how acidic the skin surface is.
  3. Why not use actives instead?  Many skincare products (serums and creams) can be formulated and ARE being formulated with better bases and fewer chemicals or irritating preservatives. It’s actually one of the goals in formulating the MadisonMD Skincare line. To preserve good, medical quality actives in better, more natural or organic bases is a beneficial trend for all – us and environment.
  4. Do they sooth? And if soothing is the goal, my question would be:
    1. “Why does it need soothing?”
    2. “Is the cleanser too harsh?”
    3. “Is the balance of serums and creams with actives not good and creating irritation?”
    4. “Are you allergic to something in the base of one of your skincare products?”

You see my point. It’s more important to find the cause of the irritation.

Hope this helps,

Brandith Irwin, MD

 

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What are you really gaining with microneedling?


I have some light scarring from SkinPen Microneedling on the neck. It’s now been a year. Is there anything that can be done to help repair the area? Can RF microneedling help? Love your website Dr. Irwin!

First we need make sure we’re talking about the same thing. Deep RF (radiofrequency) microneedling targets the dermis where collagen and elastic fibers and blood vessels are. These will bruise, swell and have some downtime.

On the other hand, superficial microneedling targets the epidermis and sometimes there’s a little collagen built in the high dermis, but not the deeper dermis.

To answer your question, it’s so individual on this type of scarring. I would recommend second opinions from a good dermatologist. It is very hard to say without seeing and feeling the area involved.

Pros and Cons of Deep Versus Superficial Microneedling

Deep Microneedling

  • Tightening… you don’t get this with superficial microneedling
  • Proven increase in elasticity (snap-back effect) with some systems (see papers on Profound).
  • Longer term results- 3-6 months to see full results and then it’s a permanent change; subject to continued aging of course.
  • Skin texture improves more, especially if it is combined with a laser for acne scarring.
  • Downtime- 3-7 days – depends on person and number of pulses. Some “yellowing” on the neck for 14 days. Cover with a sleeveless T-neck.
  • Needs topical and injectable numbing.
  • Waiting for results requires patience.
  • Complications always possible; informed consent important.

Superficial Microneedling

  • Can get superficial texture improvement (epidermis); including superficial scars.
  • Increases circulation temporarily.
  • Swelling from it makes pore size look better temporarily. But since pore size is determined by genes and amount of oil secretion, this is not permanent.
  • Increases cell turnover.
  • The slight swelling from the procedure for often makes lines look better, but then worse again at about 1 month later; a temporary effect.
  • Disruption of the epidermal layer decreases skin hydration through trans epidermal water loss. Skin looks dry and more lines after a week or two, if done too often.
  • Complications always possible; informed consent important.

Bottom Line:

Deep microneedling– After an initial series of 1-4 over 1-2 years, then perhaps every 2 years. No data on this that I’ve seen yet.

Superficial microneedling– No more than once every 3 months, in my opinion. I’d recommend a good post care moisturizer such as Madison MD Natural Lipid Moisturizer.

 

Hope this helps,

Brandith Irwin, MD

 

 

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A dermatologist’s pre-wedding skincare timeline for looking your best


SkinCare Physicians

Groom and bride leavingFor many, a wedding is the most important day in one’s life. Whether someone has a month or a year to prepare for that day, looking and feeling’s one best is important. But how and when to start? At SkinCare Physicians, we meet brides and grooms who ask for our skin care advice as they get ready for their important day. In this blog, Dr. Laurel Morton outlines a recommended treatment timeline to prepare your skin for your wedding. And, while it is always helpful when we have more time to achieve your aesthetic goals, there are some procedures that can be started even closer to the big day.

12-18 months before the wedding

Decide on your treatment goals

Healthy, smooth skin is a desired outcome for most, but you may also have other worries that include:

  • Specific concerns such as forehead wrinkles, prominent tear troughs or noticeable jaw muscles, which can be addressed with injectable techniques.
  • Skin discoloration including signs of photodamage or rosacea. These can be improved with lasers, peels and a topical regimen.
  • Body contouring including the treatment of unwanted cellulite or improving the appearance of stubborn bulges at the abdomen, hips or thighs.
  • Scarring such as that from acne or trauma. These interventions often require a series of monthly treatments, which can be planned in advance.
  • Tattoos If you’ve changed your mind about a tattoo, treatment to remove it requires months and multiple sessions for best results. Start treating tattoos as soon as possible.

Schedule a cosmetic consult

Meeting with one of our cosmetic physicians can be a useful way to prioritize your concerns and develop a strategy and personalized timeline for treatment, taking into account your budget. This can be done at any time during the planning process.

Prioritize healthy skin

There are many chronic skin conditions that can affect the confidence an individual has in his or her appearance. Chronic acne is a common problem and others may suffer from rosacea, eczema, psoriasis and more. Working with your dermatologist and finding an effective medical regimen – before the stressors of a wedding begin – is critical.

Begin a simple skin care routine

Topical skin care products are an important way to maintain healthy, youthful skin, but many require time to show their benefit. Consider fine tuning your skincare routine to include: high quality moisturizer and SPF, anti-oxidants such as Vitamin C, hyaluronic acid products for a dewy skin texture and retinols/retinoids if tolerable.

6-12 months before the wedding

Visit your aesthetician

As the wedding draws nearer, your aesthetician can help you shape a game plan to achieve hydrated skin that appears smooth and dewy. The following are just a few of the treatments our aestheticians at SkinCare Physicians offer:

Address body concerns

Cosmetic interventions such as Resonic for cellulite, Coolsculpting and TruSculpt for unwanted fat and TruFlex for muscle toning require several treatments and 3-6 months for best results. Taking into consideration dress or tuxedo fittings, start addressing any of your body concerns early on. Body contouring treatments are ideally done sooner rather than later.

Treat scars and utilize lasers for smoother skin

Laser and resurfacing procedures that depend on remodeling collagen take time to see results. Starting treatment for acne scars or traumatic scars early will allow time for your skin to respond and your collagen to remodel into results that are as smooth as possible. One of the best devices for this type of concern is the popular Fraxel Restore laser, which can be specifically adjusted for an individual’s goals.

Maintain

Fine tune your topical regimen based on your skin type and continue to work with your dermatologist to control any medical concerns.

4-6 months before the wedding

Consider laser interventions for skin discoloration

Discoloration such as redness from acne scarring and rosacea or unwanted freckles from sun exposure, can be treated in the months leading up to your big day. A series of treatments is generally required for ideal improvement.

  • Pulsed Dye or Excel V lasers address redness and blood vessels.
  • Dual Fraxel and other pigment-specific lasers such as the Ruby or Enlighten are helpful for brown discoloration.
  • Clear + Brilliant laser is useful for those with only mild pigment concerns who may also benefit from overall brightening and improved pore size.

Think about injectable interventions

Botox, Dysport and hyaluronic acid fillers are reliable for certain concerns such as wrinkles, tear troughs, etc. However, they can require touch ups over time. Start these no later than 6 months prior to a wedding in order to allow plenty of time to fine tune treatments to the desired results. Some individuals may choose to start these sooner depending on how they feel about their concerns.

Maintain

Continue your topical facial regimen and visits with your aesthetician. There is still time to visit your aesthetician even if you haven’t had a consultation yet.

0-3 months before the wedding

Give extra tender loving care (TLC) to your skin

In the last weeks leading to your wedding, be sure to provide your skin with a bit of extra TLC.

  • Keep the skin hydrated by drinking plenty of water, avoid excess dietary salt and get plenty of rest.
  • Continue strict sun protection with SPF, hats and sun-protective clothing.

Complete planned laser treatments

4-12 weeks before the wedding, finish any desired laser regimes such as those for scarring, discoloration or tattoos. You need to give your skin enough time to fully heal.

Schedule your last injectable treatments

If it’s a part of your plan, complete any injectable treatments with Dysport/Botox or Hyaluronic acid fillers at least 4-6 weeks before the wedding. Ideally, this should not be the first time you’ve had such a procedure. You want to know what to expect for results and healing time.

Consider a HydraFacial-dermaplaning treatment

This two-step treatment is done by the aestheticians and combines dermaplaning, which gently exfoliates the skin, with a classic HydraFacial, which cleanses and nourishes skin. This should be done 4-7 days prior to the big day. It allows makeup artists to have a clean, smooth palette, which leads to excellent photographs. We recommend to try this special event “Hydraplanning” treatment for the first time before a wedding shower or bachelorette party to ensure you know how your skin will respond.

Maintain

Continue your topical skin care regimen.

While you may not need all these skin care treatments, planning ahead for even the simplest skin care routine or minimal aesthetic procedure is the key to be ready and feel your best on your big day.  Now that you have a timeline and understand when to start each type of procedure, you know when to call your dermatologist or visit your aesthetician to get your skin glowing on time for your wedding.

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Big event? Wedding? Four essential tips to prepare your skin

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5 UV Protection Facts for Everyone Who Loves the Outdoors


I love being outside as much as possible. What can I do to keep my skin young and still be outdoors?

You’re really smart to connect the two because much of what we think of as “normal aging” is really just sun/UV damage. Part of the problem is that most people think “sun” as compared to “light”. And consequently, don’t think of sunscreen when it’s cloudy, or rainy etc.

Love the outdoors… you need to know this!

  1. UV light causes damage to the DNA of skin cells. It’s like a cup that you are filling over your lifetime. First it spills over into wrinkles, uneven skin color and texture, and then eventually into skin cancers.
  2. UV light is present all day long even when the sun isn’t out and through windows (UVA).
  3. UVA and UVB both cause damage. UVA is a longer ray so it tends to cause damage deeper…like collagen and elastic fibers. UVB is a shorter ray so it tends to damage the outer layer (epidermis) more and cause blotchiness and skin cancers.
  4. Zinc oxide is the only common sunscreen ingredient available that blocks both UVB and UVA most effectively. Look for 10-20%.
  5. Clothing and hats work! Going for a walk? Sunscreen and a hat make a big difference over time.

Tricky sunscreen labels

It seems like the manufacturers make this as tough as possible. The easiest thing is to just turn over the tube or bottle and look at the Active Ingredients. You want zinc oxide 10-20%. The drugstore zinc works, but are often “chalky”. For better quality ones that absorb and don’t look chalky, try Madison MD Everyday Clear UV Protection SPF 45.

Hope this helps,

Brandith Irwin, MD

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SHOULD YOU BE WORRIED? –


What is steroid acne?

Steroid acne is a kind of acne which occurs due to administration of corticosteroids in any modality. It can occur due to oral steroids, intravenous steroids, or topical steroid creams. It is characterized by a sudden onset of the rash in most cases. There is often a widespread eruption, usually occurring a few weeks after starting the steroid treatment.

Corticosteroids are important medications which are indicated in the treatment of a wide range of medical conditions, and at times their administration can be life-saving. However, steroid acne is one of the known side effects of these drugs.

People with Cushing’s Disease and Cushing Syndrome have high levels of circulating corticosteroids in their body, and are also susceptible to developing this variety of steroid acne.

Additionally, abuse of androgenic anabolic steroids can exacerbate acne vulgaris and induce severe forms of acne such as acne fulminans or acne conglobate, which is often labelled as steroid-modified acne.

Use of topical corticosteroids on the face, as part of skin lightening creams and treatments, is often unregulated and widespread in many countries around the world. Long term use of topical corticosteroids often leads to a plethora of side effects, especially on the delicate facial skin, including thinning of the skin, loss of pigment, hair growth, acne, and rosacea.

Thus, the spectrum of steroid acne can include a variety of disease presentations, and history taking remains very important in all suspected cases to pinpoint the steroid exposure.

 

Mechanism of steroid acne:

Acne induction due to steroid administration is partly due to androgen receptor binding in the skin and hair follicles, leading to hypertrophy of the sebaceous glands with consequent increased sebum output and a concomitant increase in the population density of P. acnes. These contribute to the characteristic breakouts of steroid acne.

 

Features of Steroid-induced acne:

While steroid acne resembles the classical acne (acne vulgaris) at first glance, in reality, there are some differentiating features which can help in differentiating both these eruptions, which would be easily visible to any dermatologist.

Acne Vulgaris

In predisposed individuals suspected of having steroid acne, there is often a sudden onset of follicular pustules and papules 2 to 5 weeks after starting oral corticosteroid treatment.

The lesions of steroid acne differ from those of acne vulgaris in the following ways –

  • Uniformly sized spots (monomorphic)
  • Symmetric distribution (usually on the neck, chest, and back)
  • Comedones may form later

Absence of scarring

They are often 1- to 3-mm, flesh-colored or pink-toned, dome-shaped papules and pustules.  

Acne vulgaris, on the other hand, is usually polymorphic, where there is a mixture of the lesions including comedones, papules, pustules, nodules seen at the same time. These develop over months, and gradually increase in severity, and older lesions heal with scarring ahich are intermingled with newer spots.

 

So, Should I be worried about steroid acne?

The answer to this depends on the reason or disease for which you have been prescribed corticosteroids. Generally, if you have been prescribed steroids for a life-threatening or serious systemic condition, it makes sense to ignore or delay treating any possible skin eruption until you are in better health. However, if the acne is severe, and affecting your lifestyle, it is best to talk to your doctor and possibly discuss other treatment options, especially in chronic diseases.

If the steroid acne is a symptom of an underlying disease or condition, and you are not taking any medications, it is best to get the rash assessed at the earliest.

If you are using topical steroid creams without medical supervision for long, and notice an outbreak of acne, it is important to seek advice from a doctor or dermatologist as there may be other long-term effects on the skin due to the steroid use. It is never advisable to use any creams or medications without prescription and medical supervision.

 

Should I seek medical advice?

Yes, steroid acne can start suddenly and be quite widespread, it needs to be assessed and treated by a medical professional.

 

What can I do?

While you wait for the rash to settle, you can start using an over the counter benzoyl peroxide face wash twice daily for 30-60 seconds to wash the affected areas.

 

Treatment:

Steroid acne usually resolves completely once the drugs causing it are stopped. However, occurrence of this eruption is not a contraindication to steroid use, and steroids may be used again in future if indicated.

If it is not possible to stop the steroid treatment, the eruptions can be treated with the following medications –

  • Benzoyl peroxide soaps and bodywash
  • Topical benzoyl peroxide creams for overnight application
  • Topical antibiotics such as clindamycin
  • Topical sulphur lotion

These usually help to reduce the intensity and severity of symptoms and a good response is seen within 2-4 weeks of starting treatment.

 

Sources:

  1.  Habif, Thomas P. Clinical dermatology. 5th ed. Mosby Elsevier. 2010.
  2. Griffiths C EM, Barker J, Bleiker T, Chalmers R, Creamer D. Rook’s Textbook of Dermatology. 9th Ed. Wiley Blackwell. 2016.

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Laser and RF Treatments Around the Eye Area


I have had two of three treatments of Morpheus8 around my eyes. So far, it hasn’t done much. However, my concern is that I had awful bruising around my left eye, and now, three weeks later, I still have a deep red/purple mark under the left eye. No amount of makeup covers it up. If this thing stays (it does not appear to be fading), what can be done? It is now the most noticeable thing on my face! I am 72. My skin isn’t bad for my age, and I thought the Morpheus8 treatment might help improve the thin skin around my eyes a little bit. I was willing to risk « no change » but did not expect it to look worse! Thanks for any advice you can offer.

My heart goes out to you on this. Basically the Morpheus 8 is micro needling with a bit of heat added. You could perhaps say this about all RF micro needling systems, and these systems often seem the same from the marketing. However, they are engineered quite differently, and can have very different results. But how is a consumer to know this? It’s tough. Same thing for lasers. Unless you can look at a complicated spec sheet for the device and understand it, you can’t fault yourself in any way.

Just as an aside, I recently finished a re-review of the anatomy around the eyes, and it is very complicated. The skin, muscle, and fat layers are so thin. The muscular layer (think closing your eyes, squinting, etc.) is not a good target for micro needling or any HA injection. I think it’s very difficult to position a micro needling device accurately in the dermis and NOT get it in the muscle or fat. HA injections should go under the fat or just over the muscular layer – not in it.

So here are some thoughts for you:

  • Please make sure you’ve contacted your board certified dermatologist that did the treatment to let them know what happened, and to help you.
  • Your treatment was done 3 weeks ago. Usually no results (tightening) from this will be seen for at least 1-2 months.
  • Interestingly, lymphatic drainage around the eyes is easily impaired temporarily from treatments in this area. While you’re waiting to see your derm, gentle lymphatic massage twice a day may help. Using a light lotion, or HA serum very lightly (not much pressure), massage with one finger, under the eye sweeping out to your hairline.  About 5-10 seconds is good. It may help the discoloration resolve faster. More is not better!
  • Red marks may resolve more quickly with a “bruise” setting on an IPL/BBL. Your dermatologist may have one.

Hope this helps,

Dr. Brandith Irwin

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Slugging….To slug or not to slug….


This question comes from Instagram and other social media posts where there’s a ton of confusion around this topic.

What is “slugging”? It’s the practice of putting occlusive agents like or similar to vaseline/petrolatum over all sorts of other skin care products.  The purpose is to intensify the product but does it really work?

4 Reasons to Think Twice Before You “Slug.”

  1. Slugging dilutes your skin care products. Putting an occlusive agent on your skin, does nothing by itself except reduce water evaporation through the skin. This is called transepidermal water loss, but who wants to say that all the time, so it’s abbreviated TEWL. 🙂 If you put an occlusive agent over an active, it may penetrate better due to more water retention in the barrier layer (epidermis). You can’t make the product itself stronger. There’s no science that I’ve seen on using vaseline or Aquaphor over highly engineered, usually expensive, already effective skincare products. Why potentially ruin a great skincare product?
  2. Slugging changes your products formulation by changing the pH. I don’t recommend using occlusive moisturizers over these already effective products because you can alter them and lose their effectiveness. For example, if you try to intensify a retinoid this way, you may get more irritation, clogged pores, and you may get less penetration depending on how the product was formulated. But bottom line….anything acidic is not a good idea. So for sure not vitamin C, retinol (retinoid acid) or any of the alpha or beta hydroxy acids like glycolic acid, salicylic acid, etc.
  3. Slugging may cause irritation. For example, what if you have, and many people do, a low level of irritation or allergy to propylene glycol (in many skincare products). If you occlude acids, it may cause irritation. But it’s more likely it would inactivate the actives in the product. Many of these products need a certain pH initially to penetrate well. Do you want to change that?
  4. Slugging clogs pores and may cause acne. In some who are very dry, it’s almost impossible to cause clogged pores. Others, with plenty of oil of their own, many products can clog pores and often unwanted acne is the result. Some “natural oils” can do this also. This type of acne will typically show up 4-8 weeks after you start the product.  Occlusives basically don’t allow TEWL or sweat evaporation. Natural oils like jojoba and apricot, for example, don’t tend to be as occlusive as petrolatum, waxes, mineral oils, and solid nut “butters.”  These ingredients though as part of a balanced formulation may be great.

Hope this helps,

Brandith Irwin, MD

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How to get a skin assessment on Instagram with First Derm’s Instagram Messenger Bot –


The demands on public healthcare increase as populations age. At the same time, better quality care can be made possible through medical and technological innovation with smartphones. 

First Derm’s accessible, safe, and effective platform is at the forefront of the Health revolution via mobile solutions. 

Our board-certified dermatologists give accurate information regarding the possible identity of your problem, the possible treatment options to consider, and if or when you should see your doctor in person. 

Anyone with an internet connection and a camera can use our service! With a web portal and iPhone app, First Derm acts as your mobile online dermatologist. Our dermatologists have seen hundreds of different skin conditions, from eczema to malignant melanomas. 

Now access to healthcare has become even easier with First Derm’s new medical innovation:  Instagram messenger bot, where you can now get an initial free online assessment. 

HOW DOES IT WORK?

1. Open the Instagram app on your phone and go to First Derm’s profile

2. Click on “Message”.

3. When you get to the chat, you’ll see a “Start” button

4. Click there and let the magic begin

Once you have clicked on start, a message will appear with information on terms and conditions, data storage and the option to speak directly to an online dermatologist by redirecting you to the First Derm website.

5. The First Derm Chatbot will allow you to take a photo of your skin ailment

6. In a few moments, it will give you options of what it can be.

7. You can unsend your photo as soon as you get the answer: 

Once you have sent the picture, you have the option to eliminate it from the chat which will delete it from the First Derm anonymous database. You can do this by pressing the photo button that appears until a menu displays and choosing the delete option.

Get an answer, then “unsend” to delete anything from our message box. Guaranteeing your anonymity – you the user is in control.

8. You can click on each option to read more about what it means: 

9. If you want a more detailed assessment, you can ask an online dermatologist. 

When you select this option, you’ll get redirected to the First Derm website, where you can opt for any paid plans from $29.95. You will need to fill out the form and submit images of your skin condition once again. In order to follow up and review the case, you will be given an 8 digit case number to read your answer. The online dermatologists will carefully review your case and send you an answer with the possible identity and treatment choices of your skin condition.

First Derm’s board-certified dermatologists are from the United States, Australasia and Europe and are dedicated to answer your queries, successfully answering cases from 160 countries in six different languages. 

 

See what others have to say about First Derm’s Instagram Messenger Bot

Read anonymous user reviews below about and get to know their experience:

  • “Instagram Messenger Bot was a useful tool to get more information on my skin condition. I liked the fact that it not only gave me different options on what I could have but also gave me in depth information on what each disease entailed. It’s far easier than a Google Search where the information pool is so big you don’t know where to begin. 
  • “This ChatBot has helped me with my skin problem in just a few minutes. I loved it. It’s so easy to use and that’s why I loved it so much. Give it a try”. 
  • “I’m not tech savvy, but with this Chat Bot I could easily resolve the problem I’m having in my skin right now. I liked the fact that I didn’t need to give out my personal information in order to use it, and it made me feel more comfortable”. 

First Derm Instagram Messenger Bot is great for allowing peace of mind.

With 70% of cases requiring only a simple treatment, you’ll save a trip to the doctor’s office. Having this fast, easy to use free tool is inarguably convenient for users of all ages and helps to provide tangible information on any skin concern. However, the information received is to be used for medical guidance. It is not a definitive medical diagnosis or treatment plan, but rather steps that can be taken before a visit to the doctor is needed.

First Derm services bridges the gap between an internet search and an in-person dermatologist consultation. Surveys suggest that about 80% of internet users search online for information about their medical symptoms. Not only is this process time consuming, but it can often lead to misinformation. First Derm’s Instagram Messenger Bot brings the perfect solution for all netizens.

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From fibroblast treatments to home microneedling….what to do?


Can I have Fibroblast treatment done to my face and eyes if I have had a knee replacement?

Hi. I just did Thermage on my upper knee area. I have two more appointments for upper arms and then another for neck and face. I have Beauty Bio’s at home micro needling kit. Is it safe to micro needle over areas that had Thermage? I also have and use a hand held pronged massager that’s supposed to work on connective tissue. Is this device (called the fascia blaster) safe to use on areas that I’ve had Thermage on? Thanks so much! Tiffany

You all ask the best questions! Let’s tackle how to think of these. While we all like to try new things, and I do too, we also don’t like to waste money and time…. right? Marketers make a living by preying on or encouraging (depends on how you look at it :)) our hopes and fears. And one thing is for sure, we are all afraid of aging to some extent in our current culture.

How to sort out these claims

  • Does it make sense? Okay…for example the fibroblast treatment. The outer skin layer (epidermis) is very resistant to penetration. It’s hard to get skin care products, topical drugs, etc. through it. It doesn’t admit cells across it. Fibroblasts are cells so they won’t penetrate.  And ask who’s fibroblasts are these?  Are they taking a skin punch from you and then growing your own cells in the lab or are these animal fibroblasts? If so, how did they get them? Are they a live culture from a human foreskin? My vote would be to use the well researched growth factor media from live cultured human fibroblasts like AQ Serum or TNS Serum instead. These contain most of the active factors and can be absorbed more easily.
  • Can you realistically keep this up for months? Medical grade microneedling has some science behind it when used for short periods of time, at certain depths, for certain problems. There’s no data on whether using it at home on face or body parts is a good thing or a bad thing. There are reports of scars created by the wrong kind of microneedling, infections and more commonly, no results at all. How long do you need to do this to see results? Skin tightening on the body is harder to do than on the face. My vote would be be to skip the Thermage and microneedling above the knees and instead invest in one or two deep RF microneedling treatments with a good Board Certified Derm.  If you have a fat pad there, Coolsculpting or liposuction is an option.
  • Combining treatments. We don’t know at this point whether combining fascial release or fascial massage with skin treatments in the same area is a good thing or a bad thing. Improving circulation in an area improves many things. My vote would be to exercise instead to increase circulation while you are doing any skin treatments. Some steps ups, lunges, or squats at the gym would be safer. Remember too that Thermage takes 3-6 months to see results.  🙂

Hope this helps,

Brandith Irwin, MD