Kristen Stirling was recently featured in an online article from The Nashville Voyager, an online editorial that highlights inspiring stories from around Nashville, TN.

The full article is titled: Life & Work with Kristen Stirling

Article Summary:

Kristen starts by introducing herself and reviewing her educational background. She earned a degree in Mass Communication from MTSU and then attended the Belmont University School of Nursing. 

After she graduated from Belmont, Kristen worked with the Burn Unit at Vanderbilt University Medical Center and then moved to private practice in Nashville. During her years of private practice, Kristen has treated all types of dermatology conditions, including eczema, complex rashes, skin cancers, and more.

The Start of Tennessee TeleDerm

During the 2020 lockdowns, Kristen had to pivot to telehealth appointments while still being a part of a private practice network. However, after adapting to online appointments, she decided to start her own practice that focused on providing dermatology care through the convenience of telehealth-only appointments.

Rising Through 2020

Kristen discusses the ups and downs of starting a new practice during 2020. She also talks about the challenge of reaching enough patients through the digital marketing landscape, while staying within a budget. 

But even though the road has been challenging, Kristen continues to be optimistic and determined to adapt to her patient’s needs. 

What Sets Tennessee TeleDerm Apart?

Kristen reviews the unique values her clients get when setting up an account through Tennessee TeleDerm, as well as her passion for practicing medical dermatology. She shares some of her philosophies for treatment and for patient education. 

Kristen emphasizes how she puts in the time and effort to establish a great rapport with all of her patients. She also invests time into fully educating her patients about their conditions so they will feel more motivated to follow the prescribed treatment routines, and thus get better results. Setting clear expectations for her patient’s treatments is central to Kristen’s practice.

Wrapping Up

Before the interview ends, Kristen shares some life advice for readers who might be trying to start their own business.

Read the full article on the Nashville Voyager: Life & Work with Kristen Stirling

 

September is here in Tennessee, and the cool autumn weather is on its way. And while fall weather isn’t as harsh on dermatological conditions as the summer heat or the winter cold, the change of seasons can still cause some conditions to flare up. Flare-ups can be painful and annoying, here is what to do!

 

Why Does My Skin Itch in Autumn?

During the fall, in almost every region of the United States besides the south, fall brings cooler temperatures, drier air, more wind, and shorter days. With the milder weather comes all kinds of outdoor activities that expose the skin to irritants, dehydration, and even potential sunburns.

Most people are also allergic to ragweed, which peaks during the fall. Reactions to ragweed include rashes, itchy eyes, and hayfever.

 

Eczema or Atopic Dermatitis

One of the most easily recognized derm conditions that flare up when the seasons change is atopic dermatitis. This chronic condition has no permanent cure, but symptoms come and go depending on what the skin is exposed to.

If your eczema flares up during the fall and your other treatments aren’t working, visit with an online dermatologist in Tennessee to get the relief you need. If you’re just now noticing eczema symptoms for the first time, don’t wait to get it taken care of. The rash won’t go away on its own, and the sooner you get it taken care of, the more you can avoid risks of secondary infection.

 

Psoriasis

Another itchy skin condition, psoriasis shows up as a red itchy rash with patches of white or silvery scales that flake off. Patches of psoriasis are most common on the arms, legs, and scalp. 

Occasionally, symptoms may go away on their own if you encountered an irritant that you were only exposed to once. Sometimes, your body might even get used to the irritant and stop producing an inflammatory response.

Thankfully, this condition is easily treatable with medications to help relieve the itchiness and appearance of scales. 

At Tennessee Telederm, we can identify and evaluate your psoriasis to help you find the right medication. Typically, we’ll start by recommending a topical treatment before prescribing a systemic medication.

 

Dandruff

Change of seasons can make the scalp dry out, or just make you more prone to dry scalp. Dry scalp isn’t hard to treat, but it can be annoying. 

If dry scalp is the cause of your dandruff, first try to avoid washing your hair with products that dry out your scalp. Then if you’re still having problems, there are several natural remedies that you might find helpful, including:

• Coconut oil
• Tea tree oil
• Aloe vera

 

Seborrheic Dermatitis

On the other side of skin quality, when the hair or scalp becomes extremely oily, it can cause dandruff-like flakes to form. Seborrheic dermatitis might also look a lot like psoriasis, but it’s actually related to eczema. 

A seborrheic dermatitis rash occurs in areas of the body with a high concentration of sebaceous glands, such as on the scalp. 

Because seborrheic dermatitis is a chronic condition, treatments usually involve just trying to remove the scales. Typically, coal tar shampoo, petroleum jelly, or a gentle zinc cleanser will do the trick. However, for more severe cases or flare-ups, a Tennessee dermatologist may prescribe topical corticosteroids or a calcineurin inhibitor to alleviate symptoms.

 

Pityriasis Rosea

Pronounced pit-ih-RYE-a-sis, this type of rash can occur at any age but appears mostly in young adults. Pityriasis Rosea generally follows a cold. The rash first begins as a strawberry-colored ovular patch on your trunk.  This is the herald patch that is usually followed by more pink and red spots that branch out from the middle of your body. 

Thankfully, this condition is harmless and usually resolves within about 10 weeks. However, itching usually occurs with the rash, and often patients seek treatment for the itch and appearance.  

Pityriasis rosea can be easily diagnosed through an online dermatology appointment. You may be prescribed a topical steroid cream or an antihistamine to help reduce symptoms.

 

Hives

Medically known as urticaria, hives are an allergic rash that has one or more of the following symptoms:

• Itchiness
• Red welts
• Raised welts
• Itchy skin-colored welts

 

Because hives are caused by an allergic reaction, there are many possible causes. Food, insect stings, sun exposure, medication, or other diseases might be at the root of the flare-up.

During September and October, ragweed levels are particularly high. And because most people are allergic to ragweed, it’s a common cause of hive flare-ups.

Usually, symptoms will fade on their own, but if the itching is severe and is hard to control with over-the-counter medications, a dermatologist can prescribe stronger topical medications to relieve your symptoms.

 

Beware of Sunburns

While not really a flare-up in the sense of rashes, sunburns can still happen during the fall. Cooler temperatures and overcast skies are no excuse to go without sun protection or sunscreen.

No matter how cloudy it is during the day, the sun’s UV rays are still hitting your skin and will damage it if you leave it unprotected.

 

Dry Skin and Dry Lips

Even if you don’t have eczema or psoriasis, the cooler and drier air in the fall will probably still affect your skin at some point. Also, it can get windy in the fall, which further aggravates dry skin problems.

The simple solution is to moisturize and protect your skin daily.  Be sure to use a moisturizing cream during the fall and winter months.  Save the lighter skin lotions for summer.  

If your skin is still drying out, it might be time to take slightly cooler showers. You don’t have to take a freezing cold shower, but you should avoid taking extremely hot showers. As the hot water evaporates off of your skin, it will take a lot of your skin’s natural moisture with it.  

 

Treatment for Fall Skin Flare-Ups with TN Telederm

Set up an appointment with a Tennessee board-certified dermatology professional through our patient portal. Get help identifying fall skin rashes and conditions so you can get the best treatment to relieve your symptoms. Get treatment for your itchy skin flare-ups from the comfort of your own home!

 

The teen years are an essential time for nailing your skincare habits because they’ll stick with you through the rest of your life. To help you get started with creating and sticking to your skincare plan, here are a few essential tips approved by a dermatology professional.

 

Wash Your Face Two Times a Day

Washing your face twice a day is a delicate topic! Especially, when it comes to teen acne. 

We’ve been so oversold on cleansing the skin that many people over-cleanse with washes, scrubs, toners, etc. This leaves their skin dry, parched and irritated. Then we overcorrect by limiting our washing and adding too much moisturizer.

So the point of this is to say, YES, you need to wash your skin twice a day with a basic over-the-counter cleanser that suits your skin type! But anything beyond a cleanser, like scrubs or witch hazel, is probably unnecessary. And remember, a cleanser is only touching your skin for 15-20 seconds twice a day. So, it’s not going to cure any skin condition or dramatically worsen it.

Washing your face twice a day also removes more than just makeup and oil. Washing also removes airborne contact pollutants and allergens that build up on the skin. Leaving these chemicals on the skin can cause itching, rashes, and other skin texture changes.

It’s also good to wash these chemicals off because they can actually dry out the skin. So washing your skin, in many cases, helps the skin stay hydrated. Lastly, skincare products always work better on clean skin, where there is nothing impeding product absorption.

What Kind of Cleanser Should I Use?

Because the skin on your face is slightly more sensitive than the skin on the rest of your body, so you’ll need to treat it a bit more gently. For example, you don’t want to use any kind of cleanser or moisturizer that would be heavy on the skin.

For that reason, you should use a gentle oil-free cleanser to remove makeup, dirt, and oil (sebum).

So even if you have dry or sensitive skin, you still need to wash twice a day using a gentle cleanser such as Cetaphil, Vanicream, or CeraVe. These cleansers are effective without overdrying or irritating the skin.

 

Wear Sunscreen Every Day

Use sunscreen every single day, no matter what the weather is like. Whether it’s cloudy or not, the UVA and UVB rays from the sun are still hitting your skin and causing damage. A little bit of sunshine is necessary for your overall physical well-being and your mental health, but any more than 15-20 minutes of direct sunlight will start to cause problems.

Now, you don’t have to use an entire bottle of sunscreen every day, just enough to cover the skin that’s exposed to the sun. Don’t forget to apply sunscreen to your neck and hands while you apply sunscreen.

Also, there is a difference between sunscreen and sunblock. Sunscreen is the spray-on stuff that absorbed UV light through chemical reactions. But sunblock is made with titanium dioxide and zinc oxide it and creates a physical barrier on the surface of your skin that reflects UV light. The zinc in sunblock is also what can make your skin appear paler than normal.

 

Find a Makeup with SPF

Take care of two things at the same time by finding makeup that matches your skin tone, with an added SPF. It doesn’t need to be a very high SPF, in fact, most makeup brands have a light SPF of around 15 to 30, which will be enough to protect your skin throughout the day.

Find The Makeup That Fits You

Wear makeup that matches your skin tone and doesn’t clog pores or irritate sensitive skin.

You want to find makeup that matches your natural skin tone. Pay attention to your skin’s natural tones and make sure they don’t clash with your foundation. When you’re shopping for a foundation, look for a powder-based foundation, because they’re less likely to lead to acne.

Finally, you’ll also want to find makeup that doesn’t irritate your skin. Be aware, some people can develop allergies to products after a year or more, so you might have to change which products you use.

And remember, whenever you put on makeup, you should always wash it off at the end of the day to prevent buildup in your pores.

 

“Hydrate, Don’t Diedrate”

This isn’t a saying you would hear from a dermatologist in Tennessee, but it’s catchy and there’s some truth to it too. Drinking water throughout the day is super important. Not just for your skin, but your body in general. You don’t have to drink a gallon of water each day–that’s a bit overkill. 

A good general rule of thumb is aiming for at least 8 cups of water per day. Everyone is different though, so you might need more or less, especially depending on the weather or by how much you exercise.

Just pay attention to when you’re feeling thirsty and drink plenty of water to keep your skin hydrated throughout the day.

 

Don’t Chase a Tan

As appealing as it is to get a golden sun-kissed look, tanning causes serious damage to your skin. Especially over a long period. That being said, you should still get some sun every day, but do your best to avoid tanning beds, sunburns, and too much time in direct sunlight. 

The more you expose yourself to the sun, the higher your risk of skin cancer will be in the future.

 

Get Enough Sleep

The number one way to prevent crow’s feet and dark circles under your eyes is to get enough sleep. Staying up late can be fun, especially as a teenager with homework, hanging out with friends, texting people, and so on, but you need sleep. You should get at least 8 hours of sleep every night. The CDC even recommends teens should get somewhere between 8 to 10 hours of sleep. 

The number one dermatology reason you should get enough sleep is so you don’t look tired all the time. Other benefits of sleep include:

• Better moods and mood regulation
• Reduced risk of anxiety and depression
• Improved muscle and injury recovery
• A stronger immune system
• Better focus and clearer thoughts
• Increased metabolism efficiency
• Reduced risk of obesity
• Overall healthier skin

 

Treat the Skin on Your Face Differently

The skin on your face is different from the skin on your hands and body, so you’ll need to take care of it a little differently. For instance, facial skin is thinner, more sensitive, and more prone to sebum accumulation than other areas of skin. In contrast, the skin on the rest of your body is thicker, but also drier.

Skincare products for your face moisturize your skin either after or while you cleanse your face every day. Regular eye cream application can also help you prevent getting lines, wrinkles, and shadows under your eyes.

 

Don’t Pop Pimples

It almost goes against nature to not pick pimples, but you can’t pop them anymore. When you notice a blackhead or whitehead forming, avoid touching it because it could irritate or even infect the lesion. The same goes for picking at acne as this can cause more breakouts, scarring, or cause serious infections.

If you have started seeing acne scars after picking at active acne lesions, you might be able to reduce some discoloration scars or even some of the physical scars. To learn more about acne treatments and prevention, read:

Acne: Types, Locations, and Treatments

 

How to Get Rid of Pimples

Even with the best skincare regimen, pimples can still be unavoidable. As stated above, don’t touch them or pick at them. Instead, keep up with your regular daily skin washing habits. 

If a particular zit is giving you problems, covering it in a hot towel or hot washcloth for a few minutes. Eventually, the pimple will drain on its own and usually heal smoothly without signs of scarring. But depending on the type of acne and how inflamed the lesion is, there may still be some signs of scarring.

 

Are There Natural ways I can get rid of acne?

No one likes having acne standing out on their face. So, is there anything that can be done to make acne go away fast? Here are a few go-to ways for treating acne to make those red bumps fade fast.

 

Benzoyl Peroxide

Available in gels, cleansers, and pre-treated wipes, this medicine should only be applied on the surface of the skin. Benzoyl peroxide is especially helpful when catching acne in the early stages of a breakout. When applied, the medicine gets into the pores and kills the bacteria responsible for the pimple.

If you have any dry or raw skin, you shouldn’t use this medication directly. 

 

Salicylic acid

This is another great option for cleaning up acne. When applied to acne, this acid exfoliates the skin and breaks up the bonds between dead skin cells, which helps unclog the pores. You should be aware that salicylic acid can also leave your skin feeling dried out, so moisturize accordingly.

 

Retinoids

A quintessential part of any skincare routine, retinoids help fight acne for almost all types of skin by removing excess oil and breaking up dead skin cells. Retinoids are also a notoriously strong exfoliant, so be careful not to overuse them. If you’re new to using retinoids, try just using them once every other day or so.

 

Online Dermatology Skin Care Appointments for Teens

Need more help figuring out your skincare routine? Visit the get started page to make an appointment with Kristen Stirling for dermatology advice and convenient skincare appointments that fit your schedule.

Kristen Stirling, NP, was interviewed by Helen Massy for an article, “Yes, All Warts Are Caused by HPV” on the sexual health article site, Giddy. The article provides a general overview of warts, genital warts, and wart prevention.

Below are some common questions about warts that the article answers. For more information, be sure to read the full article on Giddy.

Why do people get warts?

Kristen: “HPV (human papillomavirus) is the virus that causes all warts.” She also explains there are many known HPV strains, but only a minority of these strains cause warts.

How easily do warts spread?

Massy: “HPV is the most common sexually transmitted infection in the United States.” She then references the CDC’s report that almost all sexually active men and women contract HPV during their lifetime.

Kristen: “Frequent or vigorous contact with [genital warts] can spread the virus elsewhere on the body or to another person.” She goes on to explain that if you have a common wart on your hand and you shake hands with someone, the virus won’t spread on your skin or to anyone else. However, vaginal sex, oral sex, and anal sex can cause the virus to spread.

Are warts dangerous?

Kristen: “When warts are present from [HPV], they are generally just a nuisance.”

Can warts cause cancer?

Kristen: “Certain strains of HPV can cause health problems, including genital warts and cancers.”

Later in the article, Kristen explains that HPV has been identified as the cause of many new head and neck cancers in men.

Can I tell where I got warts from?

A: Massy explains that it can be difficult to know when or where you contracted HPV because symptoms can present weeks, months, or years after sexual contact with someone carrying the virus.

If you have a wart, do you have HPV?

Kristen: “All warts are an active virus.”

Can you get a blood test for HPV?

Kristen: “HPV hangs out in the skin cells where contact is made from the original host. Therefore, it’s not a virus that can be tested by a blood draw.”

Is the HPV vaccine effective?

Massy: “[The vaccine] currently protects against nine different strains [of HPV].”

Who should get the HPV vaccine?

Kristen: “The vaccine is recommended for everyone younger than 27. However, there may be cases when the vaccine is appropriate for adults between 27 and 45 years old. 

And it doesn’t just affect women, there is a startling number of new head and neck cancers from HPV in men. It is critical to vaccinate boys and men, too.”

For more information about HPV genital warts, causes, prevention, and treatment read the original article on Giddy.

To schedule an online consultation with Kristen Stirling for warts or other derm conditions, click here to Get Started.

 

Stop Hair Loss in Tennessee

What to do for your best head of hair and when to see a dermatologist.

Hair growth, loss, and other changes are frequent patient problems treated by dermatologists. Though there are dozens of over-the-counter hair repair and growth products, a dermatologist should first diagnose all hair loss and other hair concerns.

Hair growth starts at the follicle level in the dermis of the skin. The dermis is the middle layer of the skin of the three layers of your skin. This layer is home to the blood vessels, oil and sweat glands, and the skin’s immune system. Think of the follicle as something like a plant root and the dermis as nutrient-rich soil. Hair grows up from the follicle out through the dermis and epidermis.

Hair is composed of three layers of cuticle cells. These layers contain keratin and other lipid barriers to give hair strength and texture. Hair is porous, and water causes the hair to swell, making hair heavier and longer when wet.

 

What Causes Hair Damage

Like the skin, the hair weathers exposure from numerous chemicals, cold and heat in Tennessee, friction, and manipulation. Each of these processes potentially wears down the hair’s cuticle, leaving breaks, split ends, dry and unmanageable hair. The longer the hair grows, the more susceptible the hair is to this “weathering.” Examples of hair weathering include bleaching, permanent solutions, styling products and sprays, heat drying, combing, hair accessories, and hair-pulling associated with ponytails, braids, extensions.

Healthy hair requires a simultaneous reduction of weathering processes and optimal intake of nutrients to support hair growth. These nutrients include Omega 3 fatty acids, proteins, and B vitamins.

Despite good hair care and a healthy diet, many people still experience hair loss and hair thinning for various reasons.

 

Medical Conditions Can Lead to Hair Loss

As noted before, all hair loss should be evaluated by a dermatologist or dermatology nurse practitioner. The skin, hair, and nails can signal the presence of an internal medical condition outwardly. A possible internal medical condition applies to hair loss, too. There are numerous scalp conditions and systemic medical conditions that contribute to hair loss. In these cases, the underlying condition needs to be treated, as there is no hair product (shampoo, conditioner, oil, etc.) that will correct the underlying problem causing the loss.

Most hair loss is treatable or at least manageable. However, this conditioon is a personal dermatology concern, and many patients hesitate to consult with a dermatologist in Tennessee. Please, don’t hesitate or feel embarrassed to mention your hair loss to your dermatology provider. The dermatologist is trained and equipped with treatments for your hair needs!

 

 

Tips for Healthy Hair

Add protection back to the hair and minimize weathering.

• Take a multivitamin with B vitamins and Omega 3 fatty acids. These vitamins are easily found over the counter.
• Wash hair less, if able, to avoid stripping moisture from the hair.
• Use a leave-in conditioner spray after washing. If you have an oily scalp, try using it on the bottom half of the hair. Leave-in conditioner detangles the strands of hair, reducing breakage from combing wet hair. Leave-in conditioner also seals and protects the hair from styling tools and products.
• Air dry hair when possible.
• Minimize alcohol-containing styling products that can dry out hair even more. For example, try dry shampoo powder (Aveda, Odele at Target) instead of spray and try alcohol-free styling products like Kenra.
• Minimize over-processing hair with color, permanent solutions, extensions, heat. It is fashionable to change hair color routinely in TN, but too much can break down the hair and leave you with stripped, broken, and unmanageable hair.

 

Types of Hair Loss and Treatment Options

Non-inflammatory Hair Loss Conditions

Hormonal

Hair loss is associated with normal and predictable hormone shifts as we age. Hormonal hair loss can be managed with oral medications, usually with few to no side effects and minimal cost. Medications like Spironolactone for women and Propecia for men block a small amount of hormone driving hair loss. These pills do not stimulate growth; rather, they reduce loss.

Thyroid

The thyroid hormones play an essential role in many bodily functions. When the thyroid gland is not working correctly, too much or too little hormone is produced, and the person may experience multiple symptoms, including hair loss. A healthcare provider can perform bloodwork to check thyroid hormone levels and determine if your hair loss is associated with a thyroid condition.

Localized or Systemic Inflammatory Conditions

Inflammatory conditions irritate the scalp and/or loss at the follicle level. This irritation can present as scaling patches (psoriasis, discoid lupus), shiny bald spots throughout the scalp, or rapid receding of the frontal scalp hairline (alopecia areata or lichen planopilaris). The underlying inflammatory condition must be treated for the hair to stop falling out and for new hair to grow. A dermatologist can diagnose this hair loss and begin the correct course of treatment.
Treatment for inflammatory hair loss may involve local application of steroid solutions or foams or direct injection of steroids into the scalp skin. Both are very effective and have few side effects. Systemic inflammatory and autoimmune conditions like Lupus or Dermatomyositis can contribute to hair loss and should be diagnosed and treated by a Dermatologist or Rheumatologist in Tennessee.

Infections

Fungal or bacterial infections of the scalp can cause the hair to break close to the scalp. Infectious processes on the scalp tend to feel wet or weepy, painful, and spongy skin texture. Again, these symptoms should be assessed by a dermatologist to ensure correct treatment, allowing the hair to regrow.

Medication

Some medications are associated with hair loss, most commonly, chemotherapy. Hair growth resumes when the medication is discontinued, though hair color texture and thickness may be different. Other medicines that may potentially cause hair loss include anticoagulant Coumadin, Rheumatic medication Methotrexate, and rarely, cholesterol and blood pressure medications.

Shedding Events

Sometimes we shed hair after a major physical or psychological event. This hair loss is called Telogen Effluvium. For example, it is not uncommon to lose hair after childbirth or major surgery. The death of close family members and the physical and emotional toll on the body can also lead to a hair loss event. Fever associated with illness is another cause of hair loss. For example, approximately 25% of people infected with COVID-19 will notice some hair loss. These Telogen Effluvium events can last 6-8 wks or up to 6 months. Once the hair shedding event is over, the hair regrows on its own. By examining the scalp and taking a detailed history, a dermatologist can diagnose Telogen Effluvium fairly easily and recommend supportive care.

Treatments for Hair Growth

There are two well-supported options for hair regrowth. Remember, however, it is critically important to stop the loss first. Once the hair loss diagnosis is made and treatment started, you can begin to discuss if you are a candidate for hair growth treatments.

Minoxidil

Minoxidil is an over-the-counter active ingredient found in solutions, foams, and oils applied directly to the scalp 1-2 times per day to stimulate hair growth. These are affordable and safe options but can be time-consuming to apply regularly. Hair grows slowly, so patients using minoxidil should commit at least 6 months to the treatment.

PRP Injections

Platelet Rich Plasma injections are a new and exciting means for regrowing hair backed by numerous scientific studies. This procedure is performed in-office by experienced clinicians. It uses the patient’s own platelets (via a simple blood draw) and injects them directly into the scalp in areas of loss. Though it may sound a little sci-fi, it’s quite simple and very effective, usually taking less than an hour per session. Monthly sessions are needed at the beginning and occasional treatments after that. Ask your dermatologist for more information or a referral to a reputable provider in Tennessee.

 

Schedule an Appointment with a Dermatologist in Tennessee

Most hair loss conditions are easily diagnosed and treated. But don’t delay! Long periods of hair loss can lead to follicular dropout or scarring of the scalp. In these cases, hair regrowth is unlikely. See a dermatologist, get the right diagnosis and treatment, and you will be on your way to healthy hair growth again!

What is Hyperhidrosis?

Hyperhidrosis is a condition of abnormal and excessive sweating, beyond what the body requires for cooling.  Sweating is a normal and important function during times of exercise or increased temperatures to prevent overheating.  

With hyperhidrosis, however, the body sweats regardless of activity or temperature.  The amount of sweat is also excessive, leading to sweat-soaked clothing, slippery feet, and damp or even dripping sweat from the hands.  Not only is this disruptive to daily life (imagine trying to use your phone with wet hands), but can also cause embarrassment and social anxiety.  

 

What Causes Excessive Sweating?

Hyperhidrosis affects between 1-3% of the population. Typically beginning in childhood or adolescence, hyperhidrosis can persist into adulthood though it may not be as severe with age.  Hyperhidrosis is thought to be familial.  

Many patients are hesitant to speak to someone about their over sweating.  Don’t be!  For dermatologists, this is a common reason for visits.  Adolescence and young adulthood is a time when confidence and social acceptance are especially important to patients. There are many treatment options (discussed below) that are effective, safe, and affordable.  At Tennessee TeleDerm, we have many years of experience treating hyperhidrosis in teens and adults.  We want to help you live your best life without the hassle of over sweating!  

 

This blog will focus on primary hyperhidrosis, which is over sweating unrelated to other health conditions or medications.  

 

Symptoms of Hyperhidrosis

Hyperhidrosis most commonly affects the hands (palmer), soles of feet (plantar), and underarms (axillary).  These locations have more eccrine glands per centimeter than any other location on the body. Excessive sweating can also affect the scalp, face, and whole body, though these are less common.  

The key to understanding hyperhidrosis is its severity.  Though everyone sweats, hyperhidrosis is unrelenting to the extent that it causes secondary and tertiary skin problems like dermatitis, skin breakdown, or infection.  Patients with hyperhidrosis often soak through shirts and socks and need to change clothes during the day or layer to prevent outward signs of sweat.  Shoe choices are limited with plantar hyperhidrosis due to slippery soles and/or odor.  The use of common household goods such as paper products and electronics becomes difficult.  Fine motor activities using the hands such as writing, food preparation, and tools/instrument are also problematic.  

 

Effects of Hyperhidrosis

Long term effects of over sweating include:

• Stained or ruined clothing
• Ruined shoes
• Chronic odor
• Skin breakdown
• Skin irritation
• Secondary fungal infections
• Sweat marks/stains left behind on paper and fabric
• Malfunction of electronics, especially handheld devices

 

Lifestyle modifications to consider as well:

• Loose-fitting clothing
• Avoid overly hot beverages
• Avoid spicy foods
• Exercise indoors
• Use of undershirts to protect nicer dress shirts/blouses
• Wear socks with copper or silver to prevent odor and infection
• Apply light cornstarch powder daily to feet (or groin or under breasts) to absorb excess moisture
• Use of absorbent shoe inserts to catch moisture and extend the life of shoes; replace inserts as needed
• Use of antiperspirants

 

When to Seek Dermatology Care

Many patients seek care after having tried everything they can to manage this condition on their own.  Historically, patients were embarrassed to seek care for hyperhidrosis, but there is now more discussion of the condition and numerous options to treat it. Hyperhidrosis can be particularly damaging to self-esteem.

If you have sweating that you believe is excessive or interferes with your daily life, schedule an appointment with a dermatologist. There are effective and affordable prescription options for managing hyperhidrosis.  A dermatologist can guide you toward the right treatment options for your specific needs.  

 

Treatments

Oral and topical medications, as well as at-home and in-office procedures, may be utilized to treat your hyperhidrosis. 

Prescription-strength antiperspirants

Prescription-strength aluminum chloride blocks sweat a bit more than over-the-counter preparations.  However, higher concentrations of aluminum chloride can be irritating to the skin.  It is best to apply them at night. Avoid application after shaving.  Can be applied to the underarms, hands, and feet once daily.  Often daily use is too irritating to the skin and every other day application is better tolerated.  

 

Glycopyrrolate

Glycopyrrolate is an oral medication in the drug class called anticholinergics.  Anticholinergics block the parasympathetic nervous system which is responsible for sweating.  A daily dose of glycopyrrolate has been shown to reduce sweating by approximately 30-40% after 4 weeks.  However, when taking glycopyrrolate, the medication doesn’t differentiate between over sweating and other activities controlled by the parasympathetic nervous system. Therefore, your dermatologist may slowly increase your dose over time to avoid unwanted side effects.  

Topical glycopyrronium

This topical solution is designed to be applied directly to the skin via disposable wipe, blocking the eccrine gland activity locally in the skin.   In 2018, the FDA approved for use on underarms only.  It is very effective with few side effects.  

 

Iontophoresis

An at-home procedure using low-level electrical current and solution-soaked pads to pass ions through the outer layers of skin cells.  Ions temporarily block the eccrine gland activity. Some studies estimate a reduction in sweating as much as 85%.  Iontophoresis is most effective on hands and feet. The machine and supplies are available with a prescription. The upfront cost can be high, but the equipment is long-lasting and treatment is effective.  

 

Botulinum toxin injections

Botulinum toxin blocks nerve signals locally where injected.  The injections are performed in-office and can significantly decrease or stop sweating for 3-6 months after a single treatment.  Botulinum is metabolized and sweating resumes after this time and retreating is necessary. Injections are FDA approved for underarms, hands, and feet. Botulinum injections can be costly if not covered by insurance.  They are very well tolerated with rare side effects, save some pain at the time of injection.  

 

Each of these options is safe and effective, depending on the location of the hyperhidrosis. Treatments may be used in combination to ramp up treatment during warmer months and then scaled back during more manageable periods.  

 

When to call Tennessee TeleDerm

As with many skin hair and nail conditions, it is best to first consult a Dermatologist or dermatology-trained Nurse Practitioner. At Tennessee TeleDerm we accurately assess your sweating and design a treatment plan that works best for you!  Don’t let over sweating hold you back from getting the relief you need from excess sweat.     

Summer means more bug life in Tennessee, and with more bugs, come more bug bites and stings, especially if you enjoy spending time outdoors. Most bug bites are minor issues and resolve without having to seek serious medical treatment. However, there are some cases where you should seek medical attention from a dermatologist. If your reaction to bug bites or stings is severe enough you should seek emergency medical care.

Bed Bugs

   

Symptoms

Itchy red bites that often occur in a line. The bites usually form small bumps, and swelling may occur depending on how you react to them. Thankfully, bed bugs don’t carry disease, but they are still irritating and hard to get rid of.

As for where the bites occur, the bugs will bite any area of exposed skin. The back, face, shoulders, arms, legs, face, and neck are all common areas where bed bug bites occur.

 

When to Seek Derm Care

If you’re having a hard time managing the itchiness from the bites, dermatology treatment can help you manage those symptoms. Also, if the bites begin to blister or show signs of infection or an allergic reaction, you should seek dermatology care.

 

Fire Ants

Symptoms

Fire ant bites are painful and stinging. You won’t miss them when they happen. However, because of the ant’s venom the site of the bite will present different symptoms depending on how strong your allergic reaction is.

Most of the time, the bite will become an itchy red welt that lasts anywhere from 4 to 6 hours. Once the welt goes away, a small pustule will develop as the body works to contain and release the venom. Even though these lesions will be itchy, you should not scratch, open, or pop them. If you do, there is a higher chance for developing serious skin infections.

In rarer cases, the area around the bite presents a large allergic reaction. These reactions present intense itching and pain, and will become hot and painful before the swelling subsides.

Finally, if you are extremely sensitive to ant bite venom, you may experience anaphylaxis. This is a medical emergency and patients should seek care at an Emergency Department.

 

When to Seek Derm Care

Topical care for red ant bites is the best way to manage your symptoms until the swelling and itching goes away. If the bites present intense swelling, swelling, redness, and pain, then a dermatologist or dermatology nurse practitioner can prescribe a topical steroid or an oral antihistamine to help relieve symptoms.

 

Mosquitoes

Symptoms

Mosquito bites are pretty common in Tennessee. Typically a mosquito bite will become an itchy red welt from the female mosquito’s saliva. Mosquito saliva contains proteins that trigger an immune response from your body, which causes the swelling around the bite. 

 

How to Handle Itchy Mosquito Bites

Cleaning the bite around the bite with soap and water is a safe topical treatment that will help prevent further infection. You can also use pain relievers and antihistamines to manage the swelling and itching. 

 

When to Seek Dermatology Care for Mosquito Bites

In many cases, you won’t need dermatology care for mosquito bites. However, if you start getting headaches, or showing signs of a fever, you should talk to a doctor as you may be having an allergic reaction to a disease or other contaminant from the mosquito.

 

Flea Bites

Symptoms

Flea bites present itchiness immediately after the bite occurs. Around the bite will be a small red halo, and the bite itself will swell up slightly. If there are any bacteria or contaminants on your skin, they may enter your body through the bite wound and cause an infection. Redness, swelling, and blistering are common symptoms of an infected flea bite.

 

What to Do About Flea Bites

Immediately after you notice a bite, you should wash the area with soap and water. This will prevent any dirt and bacteria from causing an infection. Soothing itch creams and oral antihistamines are great ways to take care of mild symptoms.

 

When to Get Dermatology Care for Flea Bites

If the swelling and irritation in the bite area does not go away within a few days, then you should contact a dermatology expert to receive treatment. At Tennessee Telederm, dermatology nurse practitioner, Kristen Stirling, RN, APRN, and examine flea bite wounds and prescribe treatment to relieve your symptoms.

 

Chiggers

Symptoms

Chigger bites present as extremely itchy red spots in a random pattern localized to one area. The bites can be either flat or raised. Sometimes chigger bites also resemble blisters, pustules, welts, or hives. Because chiggers are so small, their initial bite is not always noticeable. However, irritating saliva from the bite will cause the area around the bite to swell and itch.

 

When to Seek Derm Care

Washing the area with soap and water is the first step to treating chigger bites. Also, if you notice a bite forming, washing the area will remove any other chiggers that may still be present. You can manage the symptoms of a chigger bite with anti-itch creams, calamine lotion, and antiseptics. You can also use ice to help reduce inflammation.

If these measures are not effective, then you should reach out to a dermatology practitioner.

 

Tick Bites

Symptoms

Depending on the type of tick, there can be different symptoms. Normally, you will find the tick still attached to your skin until it’s removed. Some ticks will swell to the size of a small marble if they’re allowed to stay attached. 

Like other types of insect bites, ticks can leave allergen-laced saliva in your skin that will cause pain, swelling, itching, and even blistering. Symptoms may become worse if you try to remove the tick. If you don’t remove it properly, its head will try to stay attached to your skin and the rest of its body can break off. As the head stays attached to your skin, it can cause itchiness and even infection.

 

When to Seek Derm Care 

If the tick bite caused unmanageable pain, itching, swelling, or redness, you should see a dermatology practitioner to get help for relieving your symptoms. 

You should also know that certain types of ticks carry diseases such as Ehrlichiosis, Lyme disease, and Rocky Mountain Spotted Fever. These are serious diseases, and if you notice any symptoms you should see a doctor immediately.

 

How to recognize Lyme Disease and Rocky Mountain Spotted Fever

• Rash
• Fever
• Chills
• Headaches
• Fatigue
• Muscle soreness
• Aching joints
• Swollen lymph nodes
• Heart palpitations
• Facial palsy (numbness or paralysis) 
• Swollen knees
• Nerve pain

 

Rocky Mountain Spotted Fever also presents symptoms such as nausea, vomiting, stomach pain, and loss of appetite. This fever is also known for presenting a rash with blackened and crusted skin around the original tick bite.

 

Black Flies

Symptoms

The initial fly bite will hurt and then leave you with a red itchy rash or welt. Thankfully, most fly bites do not spread serious diseases. However, there are some rare cases of fly bites spreading a bacterial disease called tularemia, which presents flu-like symptoms.

 

Bee Stings

Symptoms

Bee stings are an initial painful sting, followed by redness and swelling after the venom enters your system. Honey bee stings usually leave a barbed stinger embedded in your skin, so they have to be removed in a very specific manner.

The amount of pain and swelling does vary from person to person. In extreme cases, bee stings can cause anaphylactic shock in people who are extremely sensitive to the bee’s venom. If a bee sting causes anaphylaxis, you should use an EpiPen immediately and seek emergency medical care.

 

Wasp Stings

Symptoms

Wasp, hornet, and yellowjacket stings are painful and can occur multiple times because unlike bees, these insects do not lose their sting. Also, these insects tend to be very aggressive and will follow you until you’re far enough away from their nest.

 

Lice Bites

Symptoms

Lice infestations cause itching, bite marks, and sores to develop on the area of your body where the lice have infested. You might also see nits, or the larval form of lice, clinging near the roots of your hair. You might also see the adult lice in your hair. 

You should seek dermatology care if you see scabs and dirt and debris around the infested area.

 

Can I Treat Bug Bites at Home?

You might have noticed that many symptoms of bug bites and stings are manageable with simple over-the-counter medication and ointments. However, if your symptoms become severe, or do not improve with time and simple first aid, you should seek professional treatment.

 

Online Dermatology Appointments for Bug Bites and Stings

If you’re concerned about a bug bite or sting this summer, you can see an online dermatology provider within just a few days with our appointments. Visit our Get Started page to book your appointment, create a patient profile, submit pictures, and ask questions. 

The question I am asked most, by far, is “what is the best skincare regimen?”

In dermatology, we are most concerned with skin health. After all, your skin is the largest organ of your body! It is responsible for keeping pollutants, bacteria, viruses, and chemicals out while also regulating temperature and maintaining a cushion for your organs and musculoskeletal system. Whew–I’m tired just typing all of that!  

It makes sense, then, that healthy skin appears as more youthful-looking skin.

Therefore, the best skincare regimen is one that protects skin health!

The Basics of Skin Protection

Sun Protection

Too much UV damages skin cells and the DNA of the skin, leading to pre-cancer and skin cancer lesions (melanoma). Chronic sun damage causes color and texture changes that are often irreversible. 

Make sure your daily face moisturizer has mineral SPF in it. If you’re not sure, look for Zinc and Titanium which are mineral sunblocks. If you can’t find a mineral sunblock, chemical sunscreens are better than nothing, but mineral sunblocks are preferable. 

Use Gentle Products, Especially Cleansers

Not everyone has sensitive skin, but in the dermatology world, many patients do! You should avoid soaps, washes, and lotions with strong scents and artificial dyes to reduce skin itching and irritation. You should especially avoid these types of products if you’re taking care of babies and children. 

Take a Daily Multivitamin

Through the seasons of life, it can be easy to become mildly deficient in certain vitamins and minerals. When your diet lacks these nutrients, that deficiency can affect skin health. Taking a daily multivitamin can help maintain healthy levels of important nutrients when your diet or lifestyle is a bit…wayward.

Infection Control and Wound Healing

Wash your hands to prevent the spread of germs to your skin. Germs are a natural part of life and exposure to germs helps construct a strong immune system. However, there are many cases when infection can be prevented by hand washing.

You can promote wound healing by cleaning and covering wounds. All you need is plain soap and water to effectively clean your skin and any wounds. Finally, make sure to apply Vaseline and a bandage to clean skin daily until the wound heals.

The Best Skin Care Regimen Recommended by a Dermatologist

Now what you’ve all been waiting for! 

The best skincare regimen is simple: Cleanse, Protect, Repair. 

1. Cleanse

Cleansing should happen twice a day to rid your skin of dirt, oil, products, and pollutants.  

Find a non-soap, liquid face wash that suits your skin type:

• Dry
• Combination
• Oily
• Sensitive 

Face wash only touches the superficial layers of the skin. Therefore, you don’t have to worry about damaging the deeper layers of your skin from repeated use.

And you only need to use a cleanser for about 30 seconds twice a day. So don’t hem and haw too much over cleansers. 

No face wash is going to make or break your skin’s health or appearance. You can’t cleanse away skin conditions/diseases. Cleansers won’t cure acne, won’t soothe eczema, and won’t kill bacterial infections of the skin. That being said, a cleanser may keep your skin condition from worsening, but it won’t cure it. 

Either way, you should cleanse regularly, but always remember a cleanser’s effects are superficial and temporary. 

2. Protect your skin during the day with a moisturizer with SPF

The number one cause of premature aging is chronic and cumulative UV exposure. Your skin will be more healthy when UV damage is minimized.  

Look for a daily face moisturizer that suits your skin type and contains mineral-based SPF for all-day sun protection. Zinc and Titanium are minerals that block UV rays from the skin. By blocking UV every day, you reduce the risk of precancerous and skin cancer lesions, fine lines and wrinkles, and other surface imperfections. 

Don’t forget to use the moisturizer with SPF on your neck and chest too! This product is powerful so make it work hard for you! Also, many of these moisturizers with SPF come with a tint and/or anti-oxidants. These do-it-all products save time and money!

3. Repair Your Skin at Night

Repair current skin damage and protect yourself from further damage. 

There are 2 general avenues for anti-aging: 

1. Fruit acids 

Fruit acids resurface imperfections on the epidermis and stimulate collagen production and skin cell turnover.  Additionally, when acids remove superficial dead skin cells, other products like antioxidants and moisturizers absorb and work better!  Fruit acids include lactic acid, glycolic acid, retinoic acid/retinol. These can be found in various concentrations over the counter, by prescription, or in procedures like chemical peels.  

2. Antioxidants

Antioxidants fight the effects of reactive oxygen species (ROS). ROS are byproducts of ozone, pollution, and other environmental processes. Vitamins C & E are natural antioxidants for the skin. More potent antioxidants are green tea and other plant polyphenols. When used regularly, topical antioxidants fortify the skin’s defenses and reduce the effects of daily ROS exposure.

Acids and antioxidants can be used together or separately. Antioxidants are well tolerated in all skin types. However, acids can be a bit more tricky for sensitive or very dry skin. But, we have recommendations for all skin types, so we can find the perfect product for you.

 

Schedule An Appointment For More Personalized Dermatology Care

I hope these tips have helped you better understand how to build and maintain your skincare regimen. I also hope these product recommendations will guide you as you protect and take care of your skin.

If you have any questions or have skin diseases or concerns, please schedule an appointment so we can discuss them!

As women age, hormone levels shift. This shift is a normal and predictable change that occurs over the years, beginning in the fourth decade. Though these are normal and expected hormone shifts, there are often unwanted skin, hair, and nail changes. The shift in hormones is known as menopause and it can change your skin. 

Why Do Skin, Hair, and Nails Change Over Time?

Not all of the changes related to aging are exclusive to hormone shifts. Skin changes can be attributed to chronic sun exposure and chronic moisture loss, leaving the skin with an increased number of sunspots, premature laxity, ruddy tone, and texture, etc.  The weather in Nashville, TN can be drying in the winter and very sunny in the summer. These external factors can make skin changes from menopause more pronounced.

The dermis of the skin, which is the thick layer of skin below the epidermis, also produces less elastin and collagen as we age. The combination of chronic sun exposure leading to premature skin breakdown and decreased production of elastin and collagen contributes to most age-related skin complaints. 

A few basic principles for healthy skin, hair, and nails:

1. Zinc Based SPF is your best friend. Use it on your face, neck, and chest every day in Tennessee. Use it on your body when outdoors as best as you are able. Zinc is clean, organic, long-lasting, and safe over decades of use! 
2. Take a Women’s Multivitamin with Omega acids every day. There are countless benefits to ensuring you have enough Vitamin C, D, B Vitamins, Calcium, Iron, Omega 3, Omega 6. As always, make sure you consult your care provider if you have any medical conditions or take any medications.  
3. Be intentional about water intake. Most of us don’t even hit the 64oz per day recommendation. Make that your goal, and then increase as needed for the activity or season in Nashville.  
4. Talk honestly with your care providers about these changes, and don’t be embarrassed or scared! There is nothing you can ask that we haven’t already heard! If you don’t feel like your questions were not addressed, seek a second opinion. It can genuinely be challenging to keep up with all of the dermatology studies and advancements. Tennessee Telederm offers online appointments for dermatology needs which may make you feel more comfortable.
5. Age with a friend 🙂 There’s nothing better than feeling comfortable in your skin, surrounded by honest and healthy friendships.  

 

This blog will focus on the most common complaints associated with aging and methods to combat these issues. As always, speak with your healthcare provider before trying any new supplementation.

Skin dryness from decreased estrogen, leading to increased moisture loss that occurs over years to decades.

Most effectively combated by:

1. Gentle chemical exfoliation to remove dry, dead skin cells on the surface relieves dryness. This removal allows moisturizer to be better absorbed into the skin vs. sitting on top of the skin. Lactic acid solutions are tolerated well by most skin types. Glycolic acid and retinoids work very well also but tend to require a dose titration plan, and some formulations are prescription only. Tennessee TeleDerm can guide you through this process if you are not currently using an acid exfoliant.  
2. Moisturizing twice daily with a combination of hyaluronic acid (draws water in) and ceramides or emollients (hold moisture in the skin by forming a barrier on top of the skin). Make sure your morning moisturizer has an SPF of 30+. 
3. Increased water intake for whole body water replenishment, which is partially lost through the skin. This water intake should be in coordination with your care provider as certain medical conditions and medications require a delicate balance of appropriate fluid intake. A schedule for water intake is helpful too. Our thirst response can dim as we age, leading to fewer cues to stimulate thirst and water intake.  

Fine lines and wrinkles resulting from cumulative sun exposure, loss of dermal thickness, dry skin, gravity pulling the skin down, and repetitive facial muscle movement.

Most effectively combated by:

1. Chemical exfoliation with an acid, either daily or incrementally in office (chemical peels)
2. Proper moisturizing as noted above
3. Collagen supplementation*
4. Laser resurfacing
5. Microneedling
6. Botulinum toxin injections for dynamic facial muscle movement and fillers to “fill in” gaps left by the ever-thinning dermis and gravity.  

Decreased firmness and elasticity related to decreased collagen and elastin in the dermis, cumulative sun exposure, and effects of gravity over time.

Most effectively combated by:

1. Proper moisturizing, including moisturizers with green tea/caffeine, which have a temporary tightening effect.  
2. Collagen supplementation*
3. Filler injections
4. PRP procedures (platelet-rich plasma) to stimulate collagen
5. Other procedures as directed by a plastic surgeon

Skin tone and texture changes that are more superficial than wrinkles.

1. Morning moisturizer with zinc based SPF 30+ to prevent UV and blue light damage to the skin. We prefer a tinted moisturizer. Iron Oxides used to add tint to moisturizers offer additional protection from UV from the Nashville sun and Blue Light (light from electronics).
2. Acid exfoliation, as noted above to remove dull, dead skin cells from the surface of the skin.
3. Use of an antioxidant serum/cream. OPC, Green Tea, and Vitamin C are the most stable antioxidants on the skin. They protect the skin from a variety of environmental assaults, while also brightening the skin. Many daily moisturizers with SPF also contain antioxidants. However, studies have shown that the reparative processes of the skin are performed mostly at night. Therefore it is most important to use antioxidants at night. 
4. Consider taking Heliocare, an OTC supplement that protects all skin from the daily assault of free radicals. There is excellent science behind the effectiveness of this product, and I have recommended it for more than a decade. This supplement is especially beneficial when large areas of the skin are regularly exposed to the sun and anti-aging creams aren’t enough.  
5. Dark spot correctors containing hydroquinone for sunspots. These are found OTC or by RX.
6. Redness reducing products containing nicotinamide/niacinamide (B3). Available OTC.

Hair loss/hair breakage as a result of changes in estrogen, androgen, and moisture loss.

1. Most important of all, hair loss absolutely needs to be assessed by a dermatologist or dermatology nurse practitioner! Though hair loss is often attributed to age, there are medical conditions of the scalp and systemic medical conditions that can attribute to hair loss. Schedule an appointment with Tennessee TeleDerm to have your hair loss accurately diagnosed. 
2. Supplementation with Nutrafol**, an OTC supplement with collagen, saw palmetto, and other natural sources, is proven to combat hair loss associated with aging and weakened hair structure. 
3. Multivitamins, as noted above to ensure that the basic needs for hair growth are met. 
4. Add moisture and prevent breakage by using a leave-in conditioner like Pureology. Use gentle non-sulfa-containing hair products. Avoid excessive heat on the hair.

Brittle nails, secondary to decreased estrogen, collagen.

1. Keep nails trimmed shorter. The longer the nail grows, the weaker the tip becomes.
2. Add hand cream often. Moister supports the nail plate by adding a temporary emollient barrier, protecting nails from everyday chemicals, soaps, and detergents, etc.
3. Wear gloves to protect the nails when cleaning/household chores.   
4. Multivitamin and Nutrafol** supplementation.

 

Schedule an Online Consultation for Menopausal Skin Changes

If you have noticed changes in your skin, hair, or nails with age, Tennesse Telederm can help you with your dermatology needs. Advanced Practice Registered Nurse, Kristen Stirling, can provide you with an easy, online skin and hair consultation. You will receive a customized treatment plan to restore your skin after menopause. Schedule an online health appointment with ease from Nashville or anywhere else in Tennessee.

 

*Collagen supplementation has numerous studies supporting its benefit to skin hair and nails. However, the dosing of collagen is somewhat ambiguous. Always follow the instructions on the label of any supplement. 

**Nutrafol is a clinically studied combination of natural ingredients proven to increase hair growth and hair thickness in the setting of hormone-related hair loss. Tennessee TeleDerm does not receive compensation for this product; it is simply the proprietary blend with clinical evidence to back its effectiveness.