blank'/> A LITTLE BIT OF LACQUER: May 2017

May 31, 2017

Wrapping up PGY2

It's crazy to think, but June marks my last month as a first year dermatology resident - next month we move up in the ranks as second year residents and welcome a new incoming class of first years! 

A quick breakdown of residency in dermatology:
After graduating medical school:
PGY1 - Intern year, usually in general medicine, occasionally people choose a year of pediatrics or general surgery
PGY2 - first year dermatology 
PGY3- second year dermatology
PGY4 - third year dermatology
Graduate!

Depending on what you want to do, you can then do fellowship (although definitely not required), a few options include:
Mohs fellowship
Dermatopathology fellowship
Procedural fellowship 

Shirt  //  Scrub bottoms  //  Bag 

So next month I'll be a PGY3. This year has been absolutely incredible. The amount we've learned has been just unreal - as expected (and part of the reason I wanted to be at this program), the patient volume was huge, the population and pathology incredibly diverse - and my surgery skills are getting better and better! I've gotten consulted by the emergency room in the middle of the night to rule out Stevens Johnson Syndrome (and had to call the pathologist in to analyze my frozen), had to biopsy a 3 day old baby with likely Epidermolysis Bullosa, started treatment for just-diagnosed Leprosy (yup, we even have a Leprosy clinic), diagnosed way more skin cancers than I could ever count (same for scabies lol), cut out cancers and reconstructed faces, and starting to find my place in my passion which is taking care of skin of color. 

Dermatology programs all consist of the same types of stuff, but you'd be surprised how different they all are with regards to which year you do what, how much of a certain thing you actually do, etc. My program is very front-loaded (which I love), so our first year is considered harder than most by dermatology standards. We admit inpatients and cover the inpatient service as first years, cover all of the weekend call (which means seeing the inpatients and new consults for 4 different hospitals) and holiday calls, do a rotation in wound clinic (taking care of chronic ulcers), and spend most of our clinic time in our public hospital that serves those without health insurance.

Dress (love this ruffle version too!)  //  Flats (almost identical)  //  Bag  //  Bracelet

Next year (meaning next month lol) we get to do more specialized rotations - a rotation on dermatopathology, one in pediatrics, one in Mohs surgery, and more clinics with our specialty attendings - including Hair and Nails, Pigmented Lesions, and more. And no more weekend or holiday call! I'm done with that forever! 

Anyway, just sharing a little update since I can't believe we're already in June, and because so many of you always ask about how residency is set up - it really is program-dependent so I just share a bit of mine!

 
Shirt  //  Pants  //  Flats  //  White coat  //  Bag

May 28, 2017

Sunscreens!

Happy Memorial Day weekend all! Today I wanted to talk a bit about one of THE most important parts in your daily skin care - SUNSCREEN! And while most of us are good about putting on sunscreen before a day at the beach - it's important to remember that we should be wearing sunscreen everyday - not only for preventing skin cancers, but also premature aging. 

Check out the truck driver above- can you tell which side of his face got almost all of the sun and which was more protected from UV rays? It's not subtle! And especially if you're someone who suffers from dark spots (ie postinflammatory hyperpigmentation) or melasma - even a few minutes of sun exposure can keep those spots dark! So I tell all my patients, all my family, all my friends (that includes you) to wear sunscreen daily!

Here are a few favorites:

Everyday:
You knew this was coming - this has been my favorite daily sunscreen for years.

Acne-Prone
Most of my dermies love this one! The Cerave one above and the Avene one I mention below have also been fantastic for acne-prone skin - speaking from years of personal experience! I break out so easily whenever I try something new, but these 3 have been fantastic.

Sensitive skin:

Tinted:
Sheer coverage:
Just a tiny bit of color to even out skin and awesome protection!

Medium-full coverage:
Avene Complexion Correcting (love that it comes in more than just one shade - light, medium, and dark)
*This is pretty much the product I've been looking for forever and have been SO in love with it since trying it almost a month ago. Now instead of applying my Cerave and then applying my mineral makeup on top, now I just apply this on damp skin. It is thick but you can easily apply with a tiny bit of water to spread more easily. I love that it provides great coverage and a nice dewy finish. More importantly it's got titanium dioxide, zinc oxide, and iron oxides (which help also block visible light - another contributor to dark spots).

Baby/toddler:

Natural/Organic:
Blue Lizard is my favorite natural line - I linked two of my favorites above!

For reapplying: 
*We know that we should be reapplying every 2 hours or so but that is so unrealistic. What I do like doing is applying something right before my commute home (the setting sun is glaring in my face all drive home) - and a brush-on sunscreen powder is PERFECT for just this!
This is another cheaper option!



A few other tips?
I personally prefer physical blockers (ingredients like zinc oxide) to chemical blockers, but both are great for their own reasons! Not everyone likes the white/grey cast the physical blockers can give off, but when paired with a tinted formulation, I've never found it to be a problem! If you are using one that has primarily chemical blockers, make sure to apply at least 15 minutes before heading out into the sun! So no putting on the sunscreen when you're already at the beach, do it before you get in the car on the way there!

Also, for those who are "allergic" to sunscreen (it is a thing) - it's almost always because of one of these 2 ingredients - oxybenzone and PABA (para-aminobenzoic acid). If you've had a reaction to sunscreen in the past, don't think it means you're allergic to all sunscreens - just check the labels for one of these ingredients and stay away from them! Physical blockers (zinc oxide and titanium doxide) are usually a safe bet!

And remember that babies 6 months or younger shouldn't really wear sunscreen. Keep them out of direct sunlight and under the shade (we recently got a Cool Cabana for beach trips and we love it)! If they must wear it, make sure to try a small area first (apply once in the same spot for 2 days in a row) to make sure they don't have any reaction to it (a safe idea to do with anyone really) and stick with physical blockers.

And finally - don't forget to apply to areas like your ears (I've cut off way too many skin cancers from ears)! And lips (actinic cheilitis is not cute)! Not everyone wants to put sunscreen on your lips, but now there are tons of products with spf inside (I love this lip gloss and lip balm).

And for those who struggle with dark spots, I love this Concealer that not only helps camouflage those spots, but most importantly provides even more sun protection to help those marks fade.


PS - Comment over on Instagram (under the photo I used in this post) to enter a little sunscreen giveaway!

PS - I linked up many of these options using Amazon since they just have pretty much everything, but Dermstore is another online shop I love using! For things that I KNOW I buy every month or two, I buy through them because they have such a great subscribe and save option for a lot of their products! They're having an awesome Memorial Day Sale and everything on the site is 20% off
Use code MDSALE20

Shop some of the Dermstore links below:


May 16, 2017

Skin Care for Babies!

Happy Tuesday all! Today I’m partnering up with iHerb to talk to you a bit about taking care of baby’s skin! As a dermatology resident we see pediatric patients every week - and the most common condition we see is eczema! And as a mama to 3 crazy girls with skin that ranges from just dry (Liv) to full on super-sensitive/eczema prone (Elli-belly) I know firsthand what it’s like to actually try and put some of the dermatologist knowledge to use!


So today I wanted to share a few tips for baby skin care and a couple of my favorite products. First - did you know that simply using a moisturizer every day in the first 6 months can reduce rates of eczema? My Harvard Med classmate and current dermatology resident in Chicago published an amazing study a few months ago on just this - and they found that daily use of a moisturizer reduced rates of atopic dermatitis (more commonly known as eczema).

They wanted to make a cost-effectiveness argument (since moisturizer isn’t currently covered by insurance), so they really hammered in on the cheapest moisturizer available - petroleum jelly. But I mention it in clinic and I always get a bit of pushback from parents who are worried about its safety. One of our other favorite moisturizers is Aveeno Baby Eczema Therapy Cream (another brand that was used in the study too)! This (along with the Aveeno Baby Cleansing Therapy Moisturizing Wash) is what I use for Elli Belly and what keeps her skin happiest. This line is recommended by both pediatricians and dermatologists alike! 



The key is to take short baths in lukewarm (never hot) water (hot water dries out the skin too much) - in fact now that Elli is a bit older we do showers way more often - they’re easier, she seems to have more fun (we take the shower head off, turn down the pressure, and let her play with it like a sprinkler)! Remember that soap/body wash doesn’t have to lather to be effectively cleansing - I love the Cleansing Therapy Moisturizing Wash, and it doesn’t lather much, which I actually like! The more a product lathers up the more potentially drying soap it has! Immediately after the shower, gently pat dry making sure the skin is still slightly damp - and that’s when you slather on the Eczema Therapy Cream. Elli is super into being independent now so the first thing I do is give her a nice quarter size amount of cream to do with as she pleases, and then she’s more than happy to let me rub her down lol! Before bed with her last diaper change I’ll also put a bit of cream on her - particularly around her elbows and knees. 



Liv and Ro don’t have nearly as sensitive skin as El, so with them I don’t use the Eczema Therapy line. Instead for Ro I’m currently using the Aveeno Baby Calming Comfort line (I love the gentle lavender/vanilla scent - more lavender than vanilla for those who haven’t smelled it but I LOVE lavender - I even keep a small roll-on essential oil in my bag and smell it throughout the day)! 



For Ro it is so much easier to do sink baths (I love our deep bathtub but it is a killer on my back to get her washed up)! I put a small amount of the Calming Comfort Bath in the sink and fill it with lukewarm water, then we get washed up, making sure to get in between all of her five million deep creases!! She’s a pudge that one! After we rinse making sure we get all of the soap off and then do the same - putting on the Calming Comfort Lotion to still slightly damp skin (but make sure to put on diaper first - more than once Ro has fallen asleep after her little bath and massage before I could even get PJs on)! And new mamas - don’t go crazy about having to give baby a bath every day - they really don’t need it! I give Ro a bath about every other day. 



All of my products I ordered through iHerb and it was a great experience - they’re a Google Trusted Store (and you can pay with PayPal as well) and I loved that they even offer 10 cent samples (I love samples)! Shipping was great too (and they ship to over 160 countries)! On top of that they provide customer support in 10 different languages. 

In collaboration with this post they’re offering 10% off Aveeno Baby products (ends June 30th)! 

PS - Make sure that if baby has dryness or a rash that doesn’t get better with emollients (ie creams/lotions like those mentioned in this post) you see a dermatologist! Anything with significant dryness/scaling/bright red bumps/vesicles/etc may need a doctor’s prescription for either steroid cream, antibiotic cream, or antifungal cream depending on what’s going on, so don’t hesitate to get them seen! All of what I mentioned in my post above is considered more maintenance care for sensitive skin, but if there are any active issues make sure to see a dermatologist for treatment!

May 15, 2017

Instagram Round Up!

Happy Monday all!! Today I'm linking up some of the looks you've seen over on my Instagram feed or my Instagram stories (for those who have asked about my snapchat, I almost never use it anymore and almost exclusively now post all of our behind-the-scenes/day-to-day stuff on Instagram stories)! 

These last two weeks have been a bit crazy with work, an amazing conference I went to in NYC, more work and side projects,  an incredible The Weeknd concert I went to with one of my dermatology attendings, and thankfully wrapped up with a relaxing Mother's Day!

Many of you asked about this necklace I posted wearing in clinic on my Instagram stories. Believe it or not I snagged it for just about $10!! I honestly wasn't too sure about what quality it would be at such an insanely cheap price, but I've already worn it about a dozen or so times (and even Liv and Elli have worn it since they love dressing up with my stuff) and it's still going strong! I love that it can dress up any outfit (seriously - I got away with looking dressed up this day even though I was wearing my comfiest tee shirt)! 

pink shirt  //  pants  //  necklace (on sale for $10 right now!!)  //  white coat  //  shoes  //  glasses  //  bracelet


Here's a selfie of me and two other dermies - @derm.talk and @drgoodfood! I had a blast meeting them in New York City and learning about issues relevant to skin of color!

wrap "coat"/cardigan  //  grey knot top (love this short sleeved option too!) //  pants  //  shoes


His and hers drinks - N has a cold brew with coconut milk and I've got a pink drink (a strawberry acai refresher with coconut milk)! Yum! 

bracelet  //  shoes  //  jean shorts  //  button down top (just ordered 2 more of these because they're my FAVORITE - SO soft, perfect to dress up at work or down like I did here, AND they're on clearance for $10)


Me and my girls (and daddy behind the camera)! Heading to the park! 

nursing friendly top (makes nursing while baby wearing so easy, same for pumping at work) //  baby wrap  //  shorts  //  shoes (in the plover grey color)  //  tricycle 

Stay tuned this week as I'll be doing some much-requested skin-care posts - including one on skin care for little ones, the best suncreens, and my daily skin routine! Xoxo!

May 2, 2017

Baby's First Foods

Happy Monday! I hope you all had a wonderful weekend! Today I'm partnering with Stonyfield to talk a little bit about baby's first foods (which definitely includes yogurt, but I want to talk about other foods and some tips too)!

The first question I get? When is it ok to start introducing solids? And what should be first? Research has shown that parents are really confused about this - in a study conducted by ORC International and Stonyfield, at least one-third of parents admit to feeding confusion during baby’s first months, and over half feel overwhelmed by the varying opinions of early childhood nutrition. So you're note alone! It doesn't help that some pediatricians don't keep up to date with new data, so they continue sharing old, outdated information. With all of my babies I started right around 4 months with just simple rice cereal (I loved and still love this one, it's got probiotics and choline and tons of other nutrients, and is organic)! I'd mix a small amount with breastmilk and spoon-feed, gradually increasing the consistency as they got used to it. 

While I like to start first with spoon-feeding, I also love letting baby pick up foods and feed themselves from an early age. Soft, finger-friendly foods are the best (think cut up bananas, raspberries, avocado, etc)! I would introduce a new fruit or veggie and give it about 3 days before introducing something else to make sure I'd be able to identify any foods that baby may be allergic to.  So from 4-6 months my babies got just breastmilk, rice cereal, and soft fruits or veggies (either pureed or cut up). 

By 6 months I started introducing soft proteins like scrambled eggs and yogurt. Yogurt is Elli's absolute favorite (mine too, I pretty much always grab a cup of greek yogurt to eat on my drive into work every morning) - and Elli is taking after mama! But it really is such a great food - with a good mix of protein, healthy fats, and carbohydrates; the Stonyfield YoBaby yogurt is also a great source of probiotics - in fact Stonyfield YoBaby was selected as the number one pediatrician-recommended yogurt for babies 6 months to 2 years old!

So proud of herself using her spoon! 

Abandoned the spoon to get every last drop lol

To help protect your baby’s gut health, you want to ensure they’re getting enough probiotics. While naturally found in breast milk, probiotics are also found in yogurt - Stonyfield has added probiotic BB-12 to YoBaby (along with other live active cultures). BB-12 has been shown to have a digestive health benefit when consumed regularly by promoting beneficial gut bacteria and regular, soft stools. Stonyfield YoBaby is the only organic yogurt made especially for babies, and comes in lots of flavors (plain, vanilla, banana/mango, blueberry/apple and peach/pear)! 

Many parents don't introduce yogurt early because they think they aren't allowed to give dairy before age 1 - and while it is true that you shouldn't give a baby cow's milk before age 1, dairy itself is safe and yogurt and cheese are great first foods (and good sources of calcium and vitamin D). During the first year even while introducing new solids baby's first food is still breast milk, so don't feel like they need to be eating a certain amount of food or be on some strict schedule - I see it more as a way to get them introduced to new tastes and textures and a great nutritional supplement to breastmilk when using the right foods! Try to have fun with it! 

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