At-Home Skin Care Tips to Avoid Extra Trips to the Dermatologist

To help reduce the spread of the novel coronavirus, Minnesota issued a state-wide stay-at-home order in late March of 2020. Since then, millions of residents have had to drastically change their lifestyles. For most, this means working from home and making fewer trips to the grocery store. For many, it also means forgoing regular dermatology visits, especially for cosmetic procedures. Learn about the following skin care tips that may help you know how to modulate your regular routine.

But while skin care might not be considered an “essential” service, most gain both confidence and comfort in knowing that their skin is clear and healthy. If you’ve been struggling to care for your own skin, here are some at-home skin care tips to preserve skin health and avoid unnecessary trips to the dermatologist.

 

The Importance of Hand Washing – And Moisturizing

While most Americans are now familiar with handwashing’s importance, few understand the necessity of consistent hand moisturizing. If you’ve noticed dry, cracked skin on your hands and wrists, the constant soap and water use is likely to blame. To avoid potential infection, which can arise from cracked skin, invest in a high-quality moisturizer. If you’re having trouble controlling skin dryness, we recommend using two separate moisturizers – one lighter option for directly after washing and one heavier option for overnight healing.

 

Splurge on a Spot Treatment

Times of high physical and emotional stress are known to cause acne flare-ups. If you’re feeling more stressed out than usual, you’re likely having to deal with more consistent and persistent breakouts. While we will never recommend attempting an at-home extraction, we urge patients to think about investing in a high-quality spot treatment. Available over the counter, these products typically contain a high concentration of benzoyl peroxide and salicylic acid to clear up and prevent future breakouts. That said, don’t become frustrated if you can’t clear up a spot. You can always schedule an acne consultation when life returns to normal.

 

Skin Care and Relaxation

If you’re having trouble managing your stress and skin, trying an at-home facial is a poular skin care tip.  This experience can be both relaxing and productive, both giving you the chance to decompress while addressing ongoing skin care concerns. Skin care masks are widely available at grocery stores, drug stores, and online. To make the experience a little more special, consider putting some additional effort into your surroundings – use an essential oil diffuser, make a cup of herbal tea, and massage your face with at-home tools, like a gua sha stone.

 

Skin Conditions that Require Medical Attention

While many routine skin conditions don’t require immediate medical attention, others are more serious. Even if you’re trying to avoid making unnecessary trips outside, these conditions can’t wait more than a few days or weeks before getting serious.

  • Melanoma and other potential skin cancers – If you notice a new spot on your body, especially if it looks like melanoma, you’ll need to visit your dermatologist as soon as possible. Melanoma is a fast-spreading and deadly skin cancer, but the prognosis can improve significantly with early and aggressive treatment.
  • Psoriasis – While many experience mild forms of psoriasis, some types of the condition can be very serious – even life-threatening. If you suspect you have pustular psoriasis or erythrodermic psoriasis, contact your dermatologist. When left untreated, these forms of the autoimmune condition can result in severe fluid loss. Even the more common plaque psoriasis can become dangerous if the skin becomes infected.
  • Eczema – This very common condition can sometimes become serious without active symptom management. Stasis dermatitis, for example, indicates a problem with blood flow, especially in the lower legs. This, as well as other types of severe eczema, can lead to infection, which will require immediate medical attention.

 

What to Do If You Need to See a Dermatologist

If you’re experiencing a skin care emergency, you’ll likely need to access medical help. If you’re unsure whether the condition you are experiencing constitutes an emergency, Zel Skin & Laser Specialist is offering telehealth appointments. While this won’t be enough to diagnose your condition, it can be a good first step toward getting treatment if you’re worried about unnecessarily going outside.

Whether your condition can be addressed at home or in a medical setting, know that our clinics will be ready to resume a full schedule for all medical and cosmetic dermatology services. If you have an acne outbreak that won’t go away, or if you haven’t been able to access your regular wrinkle treatments, contact us to make an appointment later in the season.

When Do I Need to See My Dermatologist During the COVID-19 Pandemic?

by Adam Schmitt, MD

Is this skin growth dangerous?  How can I get refills of my medications?  Is this rash a sign of something more serious?  What should I do about my recently diagnosed skin cancer?

 

As the SARS-CoV-2 virus continues its march across the globe, and the number of COVID-19 cases surges throughout the United States, healthcare workers and patients alike are making daily judgements of what constitutes “essential” medical care.  It has many of us asking “Should I keep my doctor’s appointment?” Because the pandemic status is changing on a daily basis this is a question with which we will grapple for many weeks and months to come.  Dermatology is no exception.

 

When to See a Dermatologist

There are still many reasons to see a dermatologist during the COVID-19 pandemic, and for this reason most Dermatology offices are remaining open on a limited basis. Some conditions will require an office visit while others can be handled via teledermatology (see below). Dermatology is a visual specialty that is perfect for telemedicine consultation and dermatologists have been performing this type of care for decades. By visiting your dermatologist via teledermatology we can help divert care away from overburdened urgent and emergency care facilities.

 

 

Conditions Needing Immediate Care

As a general rule, if a lesion is growing rapidly (i.e., significant change over a 1-3 month period), bleeding spontaneously, or painful, it is worth further evaluation.  During this time, your dermatologist may advise a preliminary telemedicine visit as an initial evaluation, and may either provide reassurance or recommend a clinic appointment for a possible biopsy.  Similarly, if you notice a mole that is changing in size, shape, color, or symptoms, or is showing features of the ABCDEs of melanoma, it should be evaluated by a dermatologist, especially if you have a personal history or strong family history of melanoma.  While many rashes can be managed very well via a tele-dermatology visit, a rapidly expanding rash or a rash with other symptoms (such as fever or abdominal pain) will likely warrant an in-person visit.  Additionally, any concern for an active infection that would require intervention – such as an infected cyst that needs drainage – may necessitate a clinic visit.

 

 

What Can Wait

The American Academy of Dermatology (AAD) has communicated continuously with its members over the past several weeks.  They have provided practical guidance on topics encountered daily by dermatologists.  Among these guidelines is a recognition that each clinic will have to address their particular situation differently, based on patient population, acuity of disease, and prevalence of COVID-19 in their area.  However, certain restrictions are widely advised during the pandemic.  For instance, if not already mandated by local government authorities, all elective procedures should be deferred.  Examples of elective procedures include neuromodulator injections (e.g., Botox), filler injections, laser treatments, non-invasive fat removal (e.g., CoolSculpting), elective/cosmetic mole removals, and others.  Non-urgent medical conditions such as precancers (actinic keratoses), cysts, acne, rosacea, and hair loss are also being routinely deferred, as are chronic skin conditions, such as psoriasis and eczema.  Furthermore, in-person evaluation of limited rashes and stable skin lesions should be delayed.  Regular skin checks for patients without a history of melanoma or aggressive skin cancers are also being pushed back by most practices.

 

We understand that the issues above, while not life threatening, are very concerning for many of our patients. To that end, like many other practices, we are scheduling everyone who has any concern involving their skin, hair, or nails for a teledermatology visit. Over 90% of the time this type of visit will address the problem; for the rest, we will get them in to our clinic to see one of our dermatologists in person. This allows us to safely address all of our patients’ needs during this time of social distancing.

 

 

What About Skin Cancer?

You or someone you know may have been recently diagnosed with a skin cancer.  Fortunately, the majority of skin cancers are low-risk basal cell or squamous cell carcinomas.  The American College of Mohs Surgery, the preeminent professional society for fellowship-trained skin cancer surgeons (Mohs surgeons), has been in close contact with its members over the past several weeks and has provided informed, thoughtful guidance for its members.  The recommendation at this time is to delay the treatment of nearly all basal cell carcinomas, as the vast majority are slow-growing, and a delay in treatment is unlikely to impact the treatment course (the surgery to clear the tumor and the subsequent reconstruction).

Some of these can be treated with prescription topical creams and may not need surgery. Treatment of most squamous cell carcinomas can also be deferred, as long as no high-risk features are present.  Your dermatologist can assess and discuss this option on a tele-dermatology consult.  The urgency of melanoma treatment varies by depth of tumor invasion and presence of high-risk features, as well, and these are being addressed on a case-by-case basis.

 

 

Telemedicine/Teledermatology

Telemedicine is “the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration.” With an eye towards public safety, mitigating unnecessary exposure to potential disease carriers, and preservation of personal protective equipment, Medicare and Medicaid are encouraging a transition to telemedicine, and private insurers are following suit.  These remote visits can take two main forms: synchronous and asynchronous.  Synchronous encounters are live visits with a real-time provider-patient conversation and evaluation.  Asynchronous visits are sometimes referred to as “store-and-forward” visits, in which the patient uploads a history and photographs that the provider reviews at a later time, asks questions as necessary via a secure messaging system, and then renders a diagnosis and treatment plan.

 

In several ways, Dermatology is especially amenable to telemedicine, and many Dermatology practices already had some form of telemedicine service in place prior to the emergence of COVID-19.  With restrictions on in-office visits combined with loosening of both telemedicine regulations and medication monitoring requirements, practices are ramping up their telemedicine capabilities.  Routine follow-ups, visits for medication refills, initial evaluation of concerning lesions, and evaluation of limited dermatologic diseases are well-managed with telemedicine, with the option to recommend a clinic visit for a possible biopsy or more urgent intervention.

 

 

What You Can Do

  1. First and foremost, if you have symptoms of COVID-19, either stay at home or seek emergent care, depending on the severity of your symptoms. If a healthcare provider is exposed to a contagious patient, each subsequent patient is at risk, and disease incidence will continue to rise unchecked.
  2. Monitor your skin for any of the concerning findings discussed above. Contact your dermatologist if you feel anything needs immediate attention.
  3. If you have a biopsy-confirmed skin cancer, your dermatologic surgeon should be in contact with specific treatment recommendations based on the type of skin cancer, microscopic features, and location. If you have not heard from your provider, reach out for clarification.
  4. Utilize telemedicine services whenever possible. Check your dermatologist’s website to see if they offer telemedicine visits.  Many skin disorders can be evaluated and managed remotely, and insurers are more and more likely to cover telemedicine as the pandemic continues.
  5. If in doubt about your skin condition, call your provider; they will do their best to advise you and help you get the care you need, even if that care may be postponed for the time being. Keep in mind that recommendations and regulations are evolving daily – sometimes by the hour – and the clinic staff and healthcare providers are doing their best to accommodate patient needs while prioritizing public safety and adhering to both government mandates and medical society recommendations.  Remember: Your providers are as eager to see you as you are to be seen.  While difficult for patients and providers alike, temporary delays in access are necessary for the public’s health during this challenging time.

 

Adam Schmitt, MD, MS is a board-certified Dermatologist and fellowship-trained Mohs surgeon with Zel Skin and Laser Specialists in the Twin Cities.  He has a Master of Science in Epidemiology from the Harvard TH Chan School of Public Health and a Medical Doctorate from Case Western Reserve University School of Medicine.  He completed his residency in Dermatology and fellowship in Micrographic Surgery and Cutaneous Oncology (Mohs surgery) at the Mayo Clinic in Rochester, MN.

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