8 Things Your Dermatologist Won't Tell You

By , Robin Donovan, Health Writer
You know you should slather on the SPF and avoid the tanning bed. But when it comes to acne, aging and all things skin-related, there's a lot more your dermatologist knows than can be discussed in a typical appointment. Keep reading for a handful of topics your doc might fail to mention.
  1. I might refer you to a psychologist. 
    Although most people come to see me about conditions they can see--acne, flaky skin, a rash or other common problems--skin problems can be a sign of something more serious. For example, open sores on arms, legs or the entire body could be a sign of dermatillomania, a condition that causes compulsive skin picking. I can treat the condition topically, but a psychologist can help address the mental processes that trigger these self-damaging episodes.

    Some people also experience negative psychological effects from skin issues like acne, which can interfere with self-esteem and self-image, and sometimes even lead to depression and anxiety.
  2. Chocolate is A-OK--at least for your skin.
    A high intake of sugar and fat can be harmful to your health, but a bite of this sweet treat won't cause acne, despite what you may have heard. Neither will greasy food. So, if you must indulge, balance it out with healthy options the rest of the day, and don't worry about it ruining your glow. Get more acne myths and truths here.
  3. I care more about a few sunburns than long summers spent in the sun.
    It's more worrying to me that you had multiple peeling sunburns in the summer as a kid than if you had a lot of sun exposure in general. Why? Because as a risk factor for melanoma, research has shown that it's not the amount of time spent in the sun, but the number of sunburns that counts.

    is one of three main types of skin cancer, and the one you've most likely heard of. (The other two types are basal cell skin cancer, which usually pops up on skin exposed to sun, and squamous cell skin cancer, which is more common in darker-skinned people and skin not exposed to sun.) Of all skin cancer types, it's the most likely to spread throughout your body by entering the lymph nodes or forming new tumors in other tissue.
  4. I can't treat you as well when you're stressed.
    High levels of stress don't just mess with your mind. They also make it harder for my treatments to work. There are the obvious effects of poor sleep and junky eating habits that can be the outcome of stress. In addition, stress can worsen conditions like rosacea or psoriasis and make acne more inflamed. The good news is that treating stress and skin at the same time can multiply the benefits of seeing me, and you'll begin to look and feel better.
  5. I'm not a plastic surgeon.
    Once upon a time, there was a clear delineation between dermatologists and plastic surgeons. These days, there is much more overlap. So, you might try Botox in my office or a plastic surgeon's, or I may introduce myself as a surgical dermatologist, performing some of the same procedures a plastic surgeon might.

    So, what's the difference? I'm more focused on diseases of the skin, hair and nails, while a plastic surgeon is trained to fix structural issues (think of a cleft palette or a hand damaged by trauma) and address aesthetic concerns.

    If you have any doubt, ask me why I should perform your procedure and not a plastic surgeon, and ask me for photos of other results, especially if your procedure is cosmetic. You should also ask how much experience I have performing any procedure, and seek a second opinion with a plastic surgeon or another dermatologist if you're not convinced.
  6. Chemical peels are safer than you think.
    There are so many different types of chemical peels that, chances are, there's one that can help you. Superficial peels typically only cause mild burning, reddening and irritation.

    However, the more damaged your skin--or the more profound the change that you're looking for--the deeper the peel I'll need to use, which means an increased risk of complications and a longer healing time.
  7. Freckled faces aren't the only cause for concern.
    You probably know that lighter skinned people are at a higher risk for skin cancer, but each ethnicity has its own challenges. Whenever I consider a treatment for you, I'll evaluate the type of skin you have (normal, oily, dry or combination), and I'll consider your race and ethnicity when determining potential complications and the most effective course.

    For example, cystic acne is more common in Caucasians than other races. And African American patients' skin tends to be drier and more sensitive than their lighter-skinned counterparts. This means that they're more likely to develop razor bumps, uneven skin tone, vitiligo, discoloration (from acne, for example) and scarring.

    Ask me if I have experience working with people in your ethnic group, and don't be afraid to go elsewhere if I say no.
  8. I hate Botox parties.
    They may be legal, but neighborhood gatherings or spa parties where Botox injections are offered just aren't as safe as receiving these injections with medical supervision. Not only does alcohol consumption (which is much more likely at an evening event than in my office) make side effects like bruising more common afterward, receiving the shots in a medical setting ensures you'll receive proper treatment if anything goes wrong.

    Botox is sometimes counterfeited and expertise is needed to load it correctly into a syringe. Want to avoid an adverse reaction to a Botox knockoff? Come to my office. It may not smell like a spa, but you'll be safer, and I can help you understand potential side effects, like muscle weakness, trouble breathing, difficulty swallowing or an allergic reaction.
About the Author:
Robin Donovan is a Cincinnati-based freelance writer and magazine journalist with experience covering health, medicine, science, business, technology and design.

American Academy of Dermatology, "Stress and Skin," www.aad.org, accessed on February 25, 2014.
American Academy of Dermatology, "What is a Cosmetic Dermatologist?" www.aad.org, accessed on February 25, 2014.
B Anitha. "Prevention of Complications in Chemical Peeling." Journal of Cutaneous and Aesthetic Surgery. 2010 Sep-Dec; 3(3): 186-188.
Bryan A. Liang, Timothy K. Mackey, Kimberly Lovett. "Emerging Dangers from Direct Botulinum Access and Use." Journal of Homeland Security and Emergency Management. 2012; 9(1): Article 9.
Erica C. Davis, MD, Valerie D. Callender, MD. "Postinflammatory Hyperpigmentation," The Journal of Clinical and Aesthetic Dermatology. 2010 July; 3(7): 20-31.
Marta I. Rendon, MD, Diane S. Berson, MD, FAAD, Joel L. Cohen, MD, FAAD, Wendy E. Roberts, MD, Isaac Starker, MD, FACS, Beatrice Wang, MD, FRCPC, FAAD. "Evidence and Considerations in the Application of Chemical Peels in Skin Disorders and Aesthetic Resurfacing." The Journal of Clinical and Aesthetic Dermatology. 2010 July; 3(7): 32-43.
Mayo Clinic, "Botox party: Is it safe?" www.mayoclinic.org, accessed on February 25, 2014.
National Cancer Institute, "Types of Skin Cancer," www.cancer.gov, accessed on February 25, 2014.
National Cancer Institute, "Skin Cancer Prevention," www.cancer.gov, accessed on February 25, 2014.
Northwestern University, "Program to Treat Skin of Individuals of Color," www.northwestern.edu, accessed on February 25, 2014.
Patrick D. Cole, MD, Daniel A. Hatef, MD, Susan Taylor, MD, Jamal M. Bullocks, MD. "Skin Care in Ethnic Populations." Seminars in Plastic Surgery. 2009 August; 23(3): 168-172.
WomensHealth.gov, "Acne Fact Sheet," www.womenshealth.gov, accessed on February 25, 2014.