Fall Tips for Skincare

Seasonal changes can have a dramatic effect on your skin, even in sunny Florida! As the temperatures drop, some of your skincare needs will change. Learn how to enjoy some of the year’s best weather while protecting your skin with these tips!

1. Avoid long, hot showers and soaks in the tub

As cooler temps roll in, it might be tempting to take the chill off with a hot shower or bath soak. However, with these drops in temperature comes dry, cracked skin. Skin conditions like eczema can also intensify in cooler, dry weather. It’s best to avoid long periods of time in hot bathes and showers, because they dry out the skin and can cause redness and cracking. Try lukewarm water and moisturizing immediately after to help seal in the moisture.

2. Use moisturizer daily

Less humidity, means less moisture in the air which can strip your skin from it’s natural glow. The results in these cooler months is dry, flaky skin that can even itch. Using daily moisturizer that is more nourishing can help to hydrate and sooth. Oil-based moisturizers are generally better at helping your skin retain. Some of our favorites are CeraVe Moisturizing Cream, CeraVe Healing Ointment, Isdin Uradin 10.

3. Use Mild Soaps

Dry, flaky skin can lead to an excess of dead skin cells that can clog your pores and cause acne to develop or worsen. Sometimes the use of thicker, more intense moisturizers like mentioned above can also contribute to acne. Make sure you’re washing your face twice a day with mild soap that won’t further dry your skin.

4. Don’t stop wearing SPF!

Sun damage occurs ALL YEAR LONG! The leading cause of skin cancer and premature aging is UV rays. Even when it’s cold outside, the sun is just as intense. Always wear your SPF. Some MidState favorites are EltaMD, Isdin and CeraVe. The key ingredient in these is zinc.

5. Use a humidifier

Temperature changes don’t just happen outside, they happen inside. As it gets colder, you might be tempted to kick on the heat. Central heating draws the moisture from the air, and unfortunately from the surface of your skin. Humidifiers work by adding moisture back to not only the air around you, but your skin.

6. Exfoliate

You might have read dead skin cells above and said EW!! That’s where exfoliation comes into play. Dry skin is dead skin cells, and so exfoliating your skin is crucial. If your skin has a barrier, your moisturizer might not work as well. Physical exfoliation involves physically and manually removing dead skin cells using a product like a face scrub that contains some type of small, rough particles. Chemical exfoliants for the face slough off dead skin cells using chemicals that break the bonds between skin cells to loosen up the dead skin making it easy to wipe away. Choosing the right exfoliation type comes down to personal preference and what works well for your skin. Because physical and chemical exfoliation work in different ways, it’s also safe to incorporate both into your skincare regime. However, most dermatologists recommend chemical exfoliation as it tends to be more gentle on the skin.

7. Use hand cream

As flu season approaches (as if we don’t have enough on our plates!!) hand washing will continue to be an important part of our daily routines which results in dry, cracked hands. Add to it the cold weather, and you’re in a losing battle. After washing your hands, use a thick moisturizing cream (not lotion) that builds the barrier back up and helps you retain moisture.

8. Don’t forget your feet and elbows

Head, shoulders knees and toes! As the nursery rhyme goes, don’t forget the other parts of your body that need moisture. Use a thick cream or overnight lotion on these parts of your body when you go to bed. To really let them set in, add a pair of socks. A MidState favorite is O’keeffe’s Healthy Feet.

9. Don’t forget to eat healthy

Some of falls most treasured traditions revolve around food! Trick-or-treating, Thanksgiving and tail-gaiting can lead to an increase in processed foods. Foods that are high in refined carbs, and have a high glycemic index can cause your hormones and sugars to spike. This increase can have a negative affect on acne, and other skin conditions. Try to trade out the potato ships for another crunchy snack like carrots or celery.

10. Dress the part

Long sleeves, scarves, pants, gloves and hats are all in! Make a statement by protecting your skin while looking cute, don’t forget… the suns rays are still lurking about even when it’s fall ya’ll!

Featured Products

Eraclea- Ever-Moist Lip Balm

A deeply hydrating lip treatment that helps repair dry, distressed lips while replenishing lost moisture. It is rich in emollients, to give lips a satiny-smooth look and feel, while shea butter, jojoba, and antioxidants condition and revitalize lips.

Benefits:

  • Keeps lips soft and healthy
  • Helps repair dry, distressed lips
  • Replenish lost moisture
  • Condition and revitalize lips

EltaMD- Foaming Facial Cleanser

Give your skin a fresh start with EltaMD Foaming Facial Cleanser. A gentle enzyme and amino acid blend loosens makeup, oil and other impurities on the skin and in the pores. The thick, rich foam gently cleanses leaving your skin feeling clean and balanced.

Benefits:

  • Safe for all skin types
  • Enzymes help reduce inflammation
  • pH-balanced
  • Gentle enough for daily use, morning and night
  • Oil, paraben and sensitivity free

Skin September

What can vitamins do for our skin?

Casey Overturf, PA-C

We all know that foods rich in vitamins and minerals are good for you. They are essential for growth and development, energy production, bone growth and strength, and immune function just to name a few. But what do they do for our skin? And will topical creams and serums be beneficial for delivering vitamins into our skin or is it just a myth?

Vitamin A

Also known as retinol or retinoic acid, will reduce fine lines and wrinkles and increase skin thickness. It does so by increasing collagen and procollagen production. We also use retinols paired with hydroquinone or other lightening agents to treat dark spots and reverse sun damage because it increases skin cell turnover. Lastly, it down regulates inflammation and decreases sebaceous gland production, therefore it can be used to treat acne. Studies have shown these benefits are attainable in as little as 12 weeks of use. There are OTC and prescription strength forms of vitamin A available.

Vitamin B3

The active form is called Niacinamide. It has been proven to decrease inflammation, reduce hyperpigmentation, and increase the production of ceramides and lipids in our skin. Studies have been published showing its efficacy in improving melasma and inflammatory conditions, such as acne. We are even seeing Niacinamide included in more anti-aging creams after medical studies showed its efficacy in increasing skin elasticity and reducing red blotchiness.

Vitamin C

Or L-ascorbic acid, is a powerful antioxidant that can prevent the harmful effects of UV irradiation, boost collagen production and even reverse sun-damage. Uneven skin tone and texture can be improved by up to 10% after as little as 8 weeks of use! The reason vitamin C is typically more expensive is because it is difficult to stabilize the molecule and it needs to be at a high enough concentration to be beneficial. Dermatologists typically recommend morning application of vitamin C so that you can receive the maximum benefit from its properties since it provides photoprotection.

Vitamin D

There are many conditions in dermatology where the treatment includes topical vitamin D. It is used to decrease skin cell proliferation and is therefore often used to treat psoriasis and dry skin disorders. It can also increase the efficacy of topical chemotherapy used to treat precancers!

Vitamin E

This is another antioxidant that can prevent sun-damage. Oftentimes it is paired with vitamin C because they help stabilize each other and prevent breakdown of the molecule. Vitamin E can also help stabilize the skin barrier, so it is commonly used to treat recent scars.

Katie Keel, APRN-C

So, you wear sunscreen of at least 30 SPF and remember to reapply every two hours. You wear hats with a brim, sunglasses and sun shirts. You moisturize after getting out of the shower. You drink half your body weight in ounces of water daily. But if you are still looking to do more for your skin and you are one of the over 75% of Americans that take vitamins or supplements regularly here are some you might not be familiar with and can benefit from!
Nicotinamide – 500mg twice daily
The prevention of common skin cancers and precancers is possible by taking an inexpensive, widely available, oral pill twice daily. The pill—the vitamin B3 supplement called nicotinamide decreased the rate of new squamous cell and basal cell skin cancers by 23% compared with placebo after 1 year among patients at high risk for skin cancer. Nicotinamide also reduced the risk for developing actinic keratosis, a common precancer of the skin. In this study, patients took oral nicotinamide 500 mg twice daily and while on treatment, the patients did not develop any new AKs and had resolution of existing lesions with an average of 3 to 5 fewer actinic keratoses observed from the baseline count compared with the placebo group.
Zinc – 50mg zinc twice daily
A supplement that can make your Botox work faster and last longer? Where has this been all your life? Zinc has been found to be effective in extending the effects of botulinum toxin injections up to 30 percent. According to the Journal of Drugs In Dermatology, the results of the clinical trial of the drug showed that almost 92 percent of the patients who took zinc reported that the effects of their Botox treatments were noticed more quickly and lasted several weeks longer.
If you (or your child) has ever had a wart you know how troublesome they can be. Besides being cosmetically annoying, they can also be painful and can be quite difficult to get rid of. There have been several studies looking into recalcitrant warts and zinc supplementation. One in particular found that 87% of patients had completely clearance of their warts after two months of zinc therapy. In the study, the participants had over 15 warts and had been previously resistant to treatment. In that study the dose was 10mg/kg up to 600mg a day.
Vitamin D – dose dependent on individual blood levels
Of course the “sunshine vitamin” had to be on this list! Vitamin D is produced naturally by our skin in response to sunlight. However the UVB rays from the sun also contribute to the development of skin cancers and premature aging, so rather than foregoing your sunscreen consider starting a vitamin D3 supplement.
From a skin standpoint, vitamin D deficiency is associated with the risk of psoriasis, atopic dermatitis, chronic idiopathic urticaria (hives). Other health conditions linked to low vitamin D levels include: diabetes, heart disease, certain types of cancer including breast, colorectal, and prostate, dementia, depression, osteoporosis and more.
It is important to remember that vitamin D is a fat soluble vitamin and there is a risk of toxicity. A simple blood test can ensure you are within optimum levels.
Polypodium Leucotomos – 240mg daily – (Brand Name Heliocare)
Now to finish this list with a supplement you are (probably) not familiar with. Polypodium leucotomos – a compound from a species of fern that has been shown to protect its users from ultraviolet radiation and helps your body fight off free radicals for fewer sunburns, less long-term damage from environmental stressors, and younger-looking skin. It has also been found to be beneficial for the treatment of various skin disorders including atopic dermatitis, vitiligo, and polymorphic light eruption.

Featured Products

Isdin Mineral Brush- Photoaging defense: anytime, anywhere

Mineral Brush provides on-the-go protection against the visible signs of photoaging: the ideal complement to your daily sun protection and skincare routine. A silky, smooth, fine powder containing titanium dioxide, zinc oxide, mica and iron oxides provides protection against free radical pollution damage, blue light and infrared radiation (IR). Take it with you for photoaging defense and matte, natural coverage wherever you go!

Benefits:

  • Protects the skin from free radicals and environmental damage caused by pollution exposure.
  • Helps target uneven skin tone caused by blue light and minimize IR damage in the skin.
  • Leaves skin with a silky smooth matte finish, which reduces shine and feels beautifully soft.
  • Perfect for protecting your scalp from the sun!

Isdin- Eryfotona Actinica

isdin actinic care

Eryfotona Actinica is a fast-absorbing, ultralight emulsion providing all-mineral broad spectrum sun protection. Its innovative formula contains DNA Repairsomes®, naturally occurring enzymes which are clinically proven to repair existing sun damage. Eryfotona Actinica is the perfect lightweight sunscreen for all day use, every day.

Benefits:

  • Fast-absorbing- The ultralight mineral formula melts into skin without feeling heavy.
  • A mineral sunscreen containing photolyase enzymes, clinically proven to repair existing sun damage.
  • A silky emulsion provides the perfect base for makeup with no white, greasy finish.

Casey Overturf, PA-CRoutines

by Casey Overturf, PA-C

 

The importance of a good skin care routine, might sound unnecessary these days with some of the “quick fix” options available and full coverage makeup. To be honest, there are very few truly “quick fixes” when it comes to our skin. Even some of the amazing procedures that are offered by medical professionals will not be nearly as beneficial without the proper maintenance and follow up. Not to mention that full coverage makeup used to cover your flaws for one night might cause a week of breakouts without the proper skincare. Our skin is the largest organ in our body as you know and we must take care of it. The good news is taking care of it can be easy when you have a routine that’s right for you. This applies to anyone who struggles with a dermatological condition such as acne, dandruff, skin cancer, those fighting signs of aging, and so many more.

I will provide some ideal routines both in office and at home for various dermatology concerns below that will ensure optimal results!

Are you concerned about skin cancer?

If you have a recent history of skin cancer you should be having a skin cancer screening every 3-6 months to ensure another one isn’t popping up. If no history of skin cancer then once a year is appropriate. At home you should be applying a sunscreen every morning and every 90 minutes if spending a fun day out in the sun.

Do you struggle with acne?

You will likely see your dermatology provider every 2-3 months at first, but once we find the right plan for you it may be only every 6-12 months. For your at-home routine, the saying “less is more” applies. You don’t want to over exfoliate or over dry your skin. Use a dermatologist recommended facewash and moisturizer that is non-comedogenic (meaning it won’t clog your pores) every morning and night. The facewash may include a benzoyl-peroxide, glycolic acid, or salicylic acid. However, you will likely benefit most from a prescription strength topical retinoid, which is the first line treatment for acne. This will be applied as a pea-sized amount for the whole face every night.

Do you want to prevent or reverse signs of aging?

There are many in-office procedures available such as Botox/Dysport, fillers, chemical peels, lasers, etc. Botox or Dysport will prevent and soften fine lines and wrinkles and treatments are recommended every 3-5 months, it varies person to person on how long it lasts. For chemical peels and lasers treatments are done every 4-6 weeks until desired results are achieved and then every 3-6 months for maintenance. Fillers are used to treat volume loss and deep wrinkles and typically lasts 6 months to a year depending on the filler chosen and the area being treated. While in-office routines can greatly improve our skin, a solid at home routine can too! My favorite daily routine is starting every morning with a glycolic acid cleanser, then applying topical vitamin C followed by a moisturizer with spf. At night I recommend using a hydrating cleanser, applying a prescription strength topical retinoid and then finish with a moisturizer that includes hyaluronic acid.

Do you have flares of eczema?

If so you may need to see your dermatologist every 2-4 weeks until it is under control. Once it has calmed down and you have a maintenance treatment plan, you should come in every 6-12 months. An at-home daily routine is key for preventing eczema, just like many other conditions of the skin. Avoiding fragranced lotions, soaps, and detergents and long hot showers combined with dermatologist recommended moisturizers 2-3 times a day. For some, you may also require a prescription strength topical steroid for flares or non-steroidal cream for prevention.

If you implement a solid skin care routine no matter the concern you will find your skin is more hydrated, the tone is even and the texture is smoother on a daily basis AND… you will maintain your results! If any of this sounds daunting and you don’t know what to do because there are thousands of skincare products available these days, then please schedule an appointment with your dermatology provider. We can form a routine that is completely catered to your skin and your desired outcome!

Featured Products

Neocutis Micro Night

preview imageDelivers essential nourishment to help revitalize and rejuvenate the appearance of skin through a combination of Proprietary Peptides, glycerin and essential moisturizing lipids to provide nightly anti-aging benefits with power of micro-proteins. Non-comedogenic • Dermatologist tested • Free of color additives and fragrances • Not tested on animals.

Benefits:

  • Revitalize with Proprietary Peptides
  • Hydrates with glycerin, wheat germ oil and essential moisturizing lipids
  • Replenish

Neocutis Micro Firmpreview image

An intensive anti-aging treatment formulated specifically for the neck and décolleté. This moisturizing complex helps firm and tighten skin, support the restoration of lost collagen and elastin, and diminish the appearance of age spots and uneven skin tone. Non-comedogenic • Dermatologist tested • Free of color additives and fragrances • Not tested on animals.

Benefits:

  • Revitalize with proprietary peptides
  • Tighten, strengthen, retexturize, defend
  • Hydrates with glycerin, argan and jojoba oils and wild yam root extract

Confidence

Confidence comes from so many different places. Someone might feel confident about a physical aspect of themselves, perhaps their ability to perform something well, book-smarts or just an overall confidence that comes from happiness. This month we are focusing on confidence in not only yourselves, but MidState as providers of healthcare.

Many patients come to us for skin conditions that may not be life threatening but they affect their mental health. It’s just as important to feel good about yourself, after all self care is health care. In this months blog we will go over the different services that MidState offers that can help you boost your confidence from head to toe!

Common Skin Disorders

Some of the most common skin disorders can cause patients to be unhappy with their appearance. The good news is, there’s help! While there are a number of conditions that aren’t curable, there are treatments that MidState can offer to lessen or reduce the appearance of the issues that are associated with them and provide patients some comfort.

One of the most common skin disorders we treat is acne. In fact, acne is the most common skin condition in the US, affecting up to 50 million Americans annually. Approximately 85% of people ages 12-24 will experience at least minor acne however it can occur in up to 15% of adults. Treatment can range from creams like retinoids, benzoyl peroxide, salicylic acid and combinations of those. If a patient as cystic acne, treatment could involve prescription medications and antibiotics, as well as hormone therapy. Additionally, patients can have laser light therapy or corticosteroid injections for larger, painful breakouts. The important part is, treatment is available!

Eczema, or atopic dermatitis affects one in every 10 Americans. Typically, AD develops by age 5 and produces extremely itchy rashes that come and go. They can look like permanent goosebumps, dark patches, extremely dry skin, knots and red spots. The causes of AD are complex, and likely come from family history of AD, food allergies, asthma, your immune system, where you live, or external factors from everyday life such as tobacco smoke and pollution. Eczema is one of the conditions that cannot be cured, however proper treatment can control it. With a proper plan, you can reduce flare-ups, ease symptoms like itching, decrease your risk of developing thickened skin, lower your risk of infection. Medications like corticosteroids are prescribed and applied in conjunction with avoiding triggers to help patients.

Hidradenitis suppurativa, or HS has gotten some recent publicity as patients have taken to platforms like TikTok to bring it to light and find better cures. HS is a chronic, systemic (meaning it affects the entire body) inflammatory condition where an overactive immune condition causes inflammation under the surface of the skin. HS shows up as bumps, nodules and abscesses in the underarms, inner thighs, underneath breasts, buttocks, groin, back of the neck and ears. The cause of HS is unknown, and it can get worse overtime causing tracts or tunnels to form between abscessed deep within the skin. Some common misconceptions about HS are that it is caused by poor hygiene, or a patients weight. These are untrue, despite the exact cause being unknown it is directly linked to genetic and immune factors. Treatment options can range from antibiotics to corticosteroids, and even biologics have been used. In severe cases, surgery may be recommended to drain and separate lesions.

Botox & Fillers

Botox has been around since the late 1980’s and was invented by a Vancouver ophthalmologist and her husband, a dermatologist. In stark contrast, fillers have been used since the 1800’s when an Australian surgeon experimented with mineral oil & paraffin as soft tissue filler for facial defects! The first traditional collagen fillers however were approved by the FDA in 1981 and HA fillers in 2003.

Botox and fillers have gotten a bad rep with misconceptions like “you won’t be able to move your face”, or “you’ll look fake!” circulating around the procedures. The truth is, it takes A LOT to over do it and if you find a trained injector, board certified dermatologist or APRN/PA like at MidState your chances of mishaps are slim to none. For example, unless you’re ready to shell out $5,000+ you won’t be looking like Kim Kardashian anytime soon. It would take over 10 syringes to achieve that look, and most people are starting with less than half of that. Similarly, a trained injector won’t leave you looking lifeless or in a constant state of shock with your neurotoxins. The goal is to achieve a less stressed look, and reduce those lines and wrinkles.

Common areas that neurotoxins can be used in are-

  • Forehead
  • Frown lines (11’s)
  • Eyebrows
  • Top of the nose
  • Around the eyes/crows feet
  • Lipstick lines
  • Jawline/neck
  • Masseters (TMJ)
  • Chin (dimpling)

Some “off label” uses-

  • Hyperhidrosis (excessive sweating)
  • Migraines
  • Facial “lifts”
  • Facial “slimming”
  • Lip Flip

Common areas for filler-

  • Tear trough
  • Nasolabial folds (folds coming off the nose)
  • Cheeks
  • Marionette lines (smile lines)
  • Plump lips
  • Smooth chin
  • Rejuvenate hands
  • “Nose job”
  • Jawline

Lastly, and a new addition to the MidState line up is the Core to Floor program. While you might not associate your dermatologist with body contouring and pelvic floor treatment, the truth is physicians are always on the hunt for tools to add to their toolbox that can benefit their patients. The recent addition of the Core to Floor program that utilizes the Emsculpt Neo & Emsella devices is leaving patients with a sense of confidence like never before. Now you can tackle-

  • Core strength
  • Muscle definition
  • Back pain
  • Reverse muscle loss
  • Abdominal separation
  • Pelvic floor issues
  • Intimacy issues
  • Fat cell loss
  • Sooooo much more

The Emsculpt Neo is the first of it’s kind, simultaneously eliminating fat cells while building muscle. Back pain? Gone! Strengthen your core in four 30 minute sessions! Treatment areas include the abdomen, buttocks, arms, thighs and calves. Partnered with the Emsella, a revolutionary device that combats not only urinary incontinence, but intimacy issues, the Core to Floor program will leave you with a renewed confidence in all aspects of your life.

Featured Products

EltaMD AM Therapy Facial Moisturizer

EltaMD AM Therapy moisturizes while it smoothes skin texture and evens skin color and tone. This lightweight moisturizer stimulates the skin’s natural water system to moisturize without oil or heavy emollients. Hyaluronic acid helps increase moisture absorption and retention. AM Therapy is oil-free, fragrance-free, noncomedogenic and safe for sensitive skin.

Benefits:

  • Moisturizes and smoothes skin
  • Brightens and improves skin tone
  • Stimulates the skin’s natural water system

EltaMD PM Therapy Facial Moisturizer

EltaMD PM Therapy is oil-free, fragrance-free, noncomedogenic and safe for sensitive skin. Ceramides strengthen the skin’s natural moisture barrier. Niacinamide and antioxidants work to improve skin color and tone, while also speeding the metabolism to maximize the nightly skin repair process. Small rice protein peptides penetrate to stimulate cell growth and collagen formation, resulting in more skin elasticity. As it nurtures, revitalizes and oxygenates the skin, wrinkles fade and skin tone improves, resulting in a smoother, fresher appearance.

Benefits:

  • Strengthens skins natural moisture barrier
  • An antioxidant, peptide and ceramide blend helps diminish visible signs of aging
  • Repairs and restores elasticity and vitality

Expose Yourself

by Colby Beck, PA-C

 

Living in Florida, AKA “The Sunshine State” during the summer months is HOT. With scorching temperatures and humidity, many people tend to wear clothing such as bathing suits, shorts, and sleeveless tops that expose sensitive areas in attempt to stay cool. However, those who suffer from dermatological disorders may feel uncomfortable exposing their skin, especially in the summer. In this article, we are going to discuss options to treat these visibly affected areas so we can all feel comfortable and confident wearing those summer clothes.

Eczema, psoriasis, hidradenitis suppurativa, folliculitis, and intertrigo are only a few common skin conditions that can affect areas commonly exposed to the sun. I am going to briefly explain each condition and treatment options that are available.

  • Eczema is a chronic inflammatory skin condition that can be caused by genetics or environmental factors. It presents as an itchy, inflamed, dry rash. There are various treatment options for eczema. First and foremost, it is important to avoid known triggers (i.e. perfumes, lotions, washes, detergents, etc.) Using All brand Free and Clear detergent without any fabric softeners and/or dryer sheets, Dove sensitive skin body wash, Cetaphil or Vanicream face cleanser and moisturizers are just a few dermatologists recommended products. Eczema can also be triggered by dry skin, therefore moisturizing daily is of utmost importance. It is best to moisturize with a cream base multiple times throughout the day, and especially right after the shower. Patting your skin dry and then applying an emollient (Aquaphor, CeraVe Healing ointment, Vaseline) will help keep your skin hydrated. Prescription therapy is also used to treat eczema. Depending on the severity of your eczema, your provider may prescribe a single topical or a combination of treatments to clear your skin. Topical therapy includes topical steroids, topical calcineurin inhibitors (Elidel, Protopic), and Eucrisa. Systemic therapy may be necessary for more severe or refractory cases, which include oral steroids for quick relief or Dupixent injections for more long-term relief. Phototherapy is another treatment option that uses UV light to reduce symptoms.
  • Psoriasis is a chronic inflammatory condition that is genetic and caused by the immune system. Psoriasis presents as scaly, red, plaques, and in some cases joint pain. Psoriasis can affect any part of your skin, scalp, and even nails. It is most often triggered by infections, stress, or injury to the body. Since psoriasis is a chronic condition, it is important to identify triggers and limit them as much as possible to decrease flares. Try to find ways to decrease/manage stress in your life and decrease smoking. Treatment for psoriasis typically includes combination therapy. Providers may prescribe a combination of topical therapy (topical steroids, topical calcineurin inhibitors, topical retinoid, coal tar, or vitamin d analogue), phototherapy, systemic therapy or biologic therapy. Biologics are commonly used for psoriasis patients; especially those whose psoriasis is widespread or affecting sensitive areas such as palms/soles, genitalia, face etc. Biologics are typically injections that target specific parts of your immune system to decrease symptoms and disease process. Throughout the years, many classes of biologics have been developed that each target different parts of your immune system to alleviate symptoms. Therefore, if a patient fails one biologic, the provider can switch to a different class and see if another therapy works better.
  • Hidradenitis suppurativa (HS) is a chronic inflammatory disorder characterized by recurrent cyst/boils in the axillae, breast, groin, and buttock region. This condition is very painful and overtime can lead to severe scarring. Due to the natural course of this condition, it is important to diagnose and treat early to limit scarring. Those who have HS should wear loose fitting clothing to avoid friction and reduce flares. Weight gain also attributes to more flares therefore, losing weight can help alleviate symptoms. Smoking has been found to be a trigger for HS and patients are encouraged to quit. Treatment for HS includes washing the affected areas with antiseptic washes like benzoyl peroxide or Hibiclens. Oral antibiotics and topical antibiotics are also used to decrease bacteria and inflammation. Humira is biologic that has been approved to treat HS and many patients notice less flares being on Humira. There are also in office procedures that can alleviate painful cyst such as incision and drainage or injecting a steroid solution to decrease the inflammation. Excision of the cyst is sometimes necessary as well.
  • Folliculitis means inflammation of the hair follicles. Most women and men have probably experienced this at some point in their life, especially after shaving. This most often presents as inflamed, red, pimple like lesions. Even tight-fitting clothing can cause folliculitis due to friction. To reduce flares, you can wear loose fitting clothing and it is important to use a new razor each time you shave. Using hot water to soften hair prior to shaving, and shaving in the direction of hair growth will reduce flares as well. Treatment for folliculitis includes washing affected areas with Hibiclens or benzoyl peroxide wash. Topical antibiotics are effective for limited areas. In refractory or moderate/severe cases, oral antibiotics may be necessary.
  • Intertrigo is a rash that develops in sensitive areas such as axillae, inframammary areas of breast, and groin. It is found in the skin-on-skin areas and appears with red, inflamed, moist patches. Intertrigo starts after exposure to heat/humidity causing increased sweating and areas staying moist for prolonged periods. This condition is very commonly seen among those living in Florida due to activities such as routine yard work, walking at theme parks, and other activities done in the hot sun. Treatment focuses on keeping areas dry and clean. It is important to change out of wet/sweat soaked clothing. Providers typically prescribe a mixture of topical antifungals with topical steroids and absorbent powders to reduce symptoms and maintenance. Infections can occur in some patients and treatment with oral antifungals or antibiotics may be necessary.

Now that we have discussed several dermatological conditions that may prevent people from wearing that bikini or sleeveless top in the summer, let’s talk about something everyone suffers and can relate to…HAIR. I’m sure many can relate getting a last minute invitation that involves being in a bathing suit or shorts and a tank top and you have to jump in the shower to shave your legs, bikini area etc. It’s a burden in so many ways including time, but even worse is razor burn, and/or irritation from using shaving creams/gels. Fortunately, waxing and laser hair removal are great alternatives to shaving with a razor. Laser hair removal is a very quick and effective procedure to rid unwanted hair. It works by targeting dark pigmented hair and cannot remove “peach fuzz”. It takes multiple treatments depending on the body area, and the pain associated with this treatment is tolerable. You can always apply topical numbing prior to appointment for a more comfortable experience. Laser hair removal is definitely worth every penny to not have to worry about shaving for those last minute plans.

Lastly, I am going to address the most important thing, which is sun protection. The summer months in Florida offer so many outdoor activities such as boating, theme parks, cook outs, etc.  It’s all fun and games until the next day waking up with that red, crisp sunburn. Sunscreen is not only important in protecting your skin from skin cancer, but also preventing physical signs of aging. Sun exposure is one of the main contributors to aging and there are many ways to protect your skin. A broad-spectrum mineral based (zinc/titanium) sunscreen should be used daily on the commonly exposed areas including face, neck, chest, arms. If you are in the sun for longer periods, it’s important to apply sunscreen to all exposed areas and reapply at least every 2 hours. You may need to apply more frequently if you are sweating or swimming. Another way to protect your skin from the sun is with clothing. Wide brim hats that cover ears, neck, and face are best. Temperature regulated clothing with UPF are also great options when outside that provide coverage but not warmth.

I hope anyone suffering with any of the above conditions realizes there is treatment options available to them and calls any of our offices to get them summer ready!

Featured Products

EltaMD UV Sport SPF 50

Have your fun in the sun—but play it safe. This sunscreen is great for swimmers, skiers, runners, golfers and other athletes – or for those who just love to be outdoors! UV Sport is water-resistant so it won’t rinse off in water or drip into your eyes and sting when you sweat.

 

Benefits:

  • UVA/UVB sun protection
  • Will not rinse off in water or drip into eyes due to perspiration
  • Water-resistant (80 minutes)

Neocutis Micro Day

Revitalizing & Tightening Day Cream SPF 30. A powerful day cream that provides four benefits in one: skin revitalization, anti-oxidant care, broad-spectrum UVA and UVB protection and lasting hydration.

Benefits:

  • Revitalize with Proprietary Peptides
  • Hydrate with glycerin and sodium hyaluronate
  • Defend against free radicals with a blend of green tea extract, vitamin C and E plus melanin
  • Protect from photo aging and photo damage with zinc oxide
  • Replenish and restore moisture

Melanoma May

By Dr. Jessin Blossom

 

 

 

 

Melanoma is a type of skin cancer that develops when melanocytes (the cells that give the skin its tan or brown color) start to grow out of control. Melanoma is much less common than some other types of skin cancers. But melanoma is more dangerous because it’s much more likely to spread to other parts of the body if not caught and treated early. Skin cancer screenings are the best way to catch it in the early stages, and also the best pathway to treatment.

Melanoma can arise in a preexisting mole or show up all by themselves. Often times, it’s an irregular dark spot that you notice changes rapidly. Living in Florida, an annual skin exam is a must!!

Dermatologists have many tools at their ready to help patients diagnose their melanoma. Dermoscopy, which involves examination of the skin using skin surface microscopy, total body photography, biopsy and genetic testing of lesions. Treatment can involve excision, immunotherapy, radiation therapy and other options.

There are options when it comes to treating your other skin cancers. One that is performed here at MidState for basal cell and squamous cell carcinoma is Moh’s Surgery. Moh’s is considered a skin conservation surgery. This surgery has a unique benefit in that during surgery, the surgeon can see where the cancer stops. This isn’t possible with other types of treatment for skin cancer.

The ability to see where the cancer stops gives Mohs (pronounced Moes) two important advantages:

  1. Mohs has a high cure rate.
  2. Mohs allows you to keep as much healthy skin as possible because the surgeon only removes the skin with cancer cells. This is especially important when skin cancer develops in an area with little tissue beneath (e.g., eyelid, ear, or hand).

On the day of the surgery, your surgeon will first examine the area to be treated. You’ll then be prepped. This includes giving you an injection of anesthetic. This injection only numbs the area that will be operated on, so you’ll be awake during the surgery. Once the anesthetic takes effect, the surgeon starts by first cutting out the visible skin cancer. Next, the surgeon removes a thin layer of surrounding skin. You’re then bandaged so that you can wait comfortably in our private Moh’s patient lounge (complete with snacks and coffee!). While you wait, the Mohs surgeon looks at the removed skin under a microscope with slides prepared by our histotech. The surgeon is looking for cancer cells and clear margins. If cancer cells are found, patients would go back for a second removal of tissue. This process of removing a thin layer of skin and looking at it under a microscope continues until the surgeon no longer sees cancer cells.

Having any type of surgery can be scary. If your dermatologist recommends Mohs, you can take comfort in knowing a what to expect. Mohs has a high cure rate. Your surgeon will remove the least amount of skin needed to treat the cancer.

What’s a physical sunblock?

Some sunscreen brands might throw around the term “physical” blocker as opposed to “chemical” blocker. You might be curious what that means when it comes to the type of protection you’re getting. Physical sunblock’s such as titanium or zinc oxide do not get broken down by the suns UV rays. The same can’t be said for chemical blockers like avobenzone or oxybenzone which are degraded by sunlight. While it’s always a good idea to reapply your sunscreen, physical blockers will offer more protection in the long run.

So what’s the best physical blocker besides the ones you apply? Clothing!! Covering up in hats, shirts and clothing with a UPF rating of 50 or higher will always be the most fool proof way to prevent sunburns. Some of our favorite brands are Columbia sun shirts, and Coolibar clothing.

When it comes to head protection, a wide brim hat wins the award for best coverage. It doesn’t leave the ears, neck and cheeks exposed to the harmful rays.

Why should you pay for that?

Have you ever had that thought cross your mind when your doctor tells you their recommendations for products? Typically their cost is slightly higher, and you have to buy them in office, but your doctor has your best interest in mind.

Dermatologist “brands” have been put through more research and have science behind the ingredients in the products to ensure optimal delivery in every product. Brands are chosen with the best efficacy and stability. For example, your average over the counter vitamin C is degraded the instant you open it by heat and light. The dermatologist brand recommended and sold at MidState, Rose Skin Care, was chosen because of it’s stability in testing and it’s longevity. So while you might pay slightly more, you’re getting better results.

All the cosmecueticals sold at MidState have not only been tested by our dermatologists and staff, but they’re chosen to ensure they aren’t irritating to your skin. You wouldn’t consult a car salesman to do your taxes, so don’t listen to Tiktok or Twitter for your skincare.

May Featured Products

EltaMD UV Elements is a 100% physical sunscreen in a tinted, moisturizing base. It is gentle for even the most sensitive skin types, including post-procedure skin. Its chemical-free actives, zinc oxide and titanium dioxide, provide safe but sure sun protection. These mineral-based UV filters work with ultra-hydrating hyaluronic acid to protect and hydrate the skin. UV Elements has a universal tint that beautifully enhances most skin tones for a more youthful appearance.

Benefits:

  • UVA/UVB sun protection
  • Chemical-free UV filters
  • Hyaluronic acid boosts moisture-retention for a smoother, more youthful appearance
  • Water-resistant (40 minutes)
  • Dye-free

EltaMD UV Aero provides sheer but sure sun protection. This continuous spray sunscreen makes it easy to protect hard-to-reach places. EltaMD UV Aero sprays on white so you can see coverage then dries clear when rubbed in.

Benefits:

  • UVA/UVB sun protection
  • Continuous spray convenience
  • Water-resistant (80 minutes)

Dr. Puja KathrotiyaVitamins for Skincare

By Dr. Puja Kathrotiya

 

 

 

  1. Vitamin A derivatives

    Referred to as retinoids, or retinols

  • Can be found in over the counter skincare products as well as prescription creams

Benefits

  • Increases skin cell turnover, leaving skin looking younger, smoother and brighter
  • Increases collagen production, reduces appearance of wrinkles, fine lines and prevents skin from getting thin
  • Decreases sebaceous gland activity,  helps prevent comedone (black-head, white head) formation and treats acne
  • Anti-inflammatory, treats acne and other inflammatory skin conditions

OTC recommendations:

  • RoC retinol correxion Deep Wrinkle Night Cream
  • Neutrogena Rapid Wrinkle Repair
  • La Roche Posay Pure Retinol Face Serum
  • Elizabeth Arden Retinol Ceramidses Capsules
  • Olay Regenerist Retinol 24
  1. Vitamin B3

    Referred to as Niacinamide, Nicotinamide

Benefits

  • Helps reduce hyperpigmentation (helps treat melasma, or post-inflammatory hyperpigmentation from acne, ingrown hairs, etc)
  • Helps reduce sebum production (helps with excessively oily skin, and acne)
  • Helps decrease redness and inflammation (helps with inflammatory skin conditions such as acne, rosacea, perioral dermatitis)

OTC Recommendations:

  • CeraVe Skin Renewing Night cream
  • Paula’s Choice Niacinamide 20% Treatment
  • The Ordinary Niacinamide 10% + Zinc 1%
  • Olay Tone Perfection Serum B3 + Vitamin C
  1. Vitamin C

    Referred to as L-Ascorbic acid

  • Helps reduce hyperpigmentation (helps fade sunspots, post-inflammatory hyperpigmentation)
  • Boosts UV protection when used in conjunction with a sunscreen (keeps skin looking younger, and  thicker)
  • Helps increase collagen production (helps prevent fine lines, wrinkles and maintain skin thickness)

OTC Recommendations:

  • Neutrogena Rapid Tone Repair 20% Vitamin C serum
  • La Roche Posay Active C10 Dermatological Anti-Wrinkle Concentrate
  • CeraVe Skin Renewing Vitamin C Serum
  • RoC Multi Correxion Revive + Glow Daily Serum + Vitamin C
  1. Vitamin E

    Referred to as Tocopherol

  • A fat soluble anti-oxidant that has emollient like properties (keeps skin soft and hydrated)
  • Helps prevent against sun-damage (prevents sun-induced damage such as sunspots, freckles, and lines)

OTC Recommendations:

  • Olay Total Effects 7 in 1 Moisturizer
  • CeraVe Skin Renewing Night Cream
  • Cetaphil Deep Hydration 48 Hour Activation Serum

April Featured Products

   

An Ounce of Prevention is Worth a Pound of Cure

By Katie Keel- APRN-C & MidState Skin Institute

Now that January and February are behind us it’s time to ask – did you keep your New Year’s Resolutions? About 50% of adults in the US make New Year’s Resolutions but fewer than 10% actually keep them. If you were one of the 90% of those who don’t, it’s not too late to make a new one. One you can keep and reap the benefits for years to come. One you don’t have to wake up at 5am to get to the gym for or miss out on your favorite candy, chip, or baked good. Let’s pick one you can do in the comfort of your own bathroom and takes 2-3 minutes, the same amount of time you spend brushing your teeth. Let’s take care of our skin!

“You can’t help getting older, but you don’t have to get old.” – George Burns

At MidState Skin we like to change that quote a little bit – You can’t help getting older but you don’t have to LOOK old. This month we will discuss with you how to fight looking older, tooth and nail, but first we need a bit of background to discuss the pathology behind lines, wrinkles, skin discoloration and aging. Lines and wrinkles form from a combination of sun damage, gravity, smoking, genetics and muscle movement.

Although some of these things we don’t have control over, the good news is many of these factors we do have control over. First, sun damage – in case you haven’t heard, sunscreen is your friend. The key is finding one that is a physical or mineral sunscreen that contains active ingredients like zinc oxide and titanium dioxide. Apply it every morning even if it’s raining or you “aren’t going anywhere”. It is the little bit of sun exposure every day while driving in the car, walking to get the mail or into the store that accumulates and accelerates skin aging.

Gravity – darn you Sir Isaac Newton, can’t control this one, we will skip it.

Smoking – if you never have, never start, and if you currently smoke there are so many options to help quit. On average it takes seven times to successfully stop smoking. If you slip, get back up and try again. You are not alone.

Genetics – quite literally you can’t live without them. We all have that friend that uses only water to wash their face and Ponds Cold Cream to moisturize and doesn’t have a single spot, line, wrinkle, or acne bump. More likely than Ponds Cold Cream being a miracle product, your friend probably is just blessed with that skin genetically.

Notice we saved the best for last – muscle movement. Despite great advertising and famous paid spokespeople there is nothing topically that will decrease the muscle movement beneath the skin which is driving the collagen loss and furrows and lines. We call these dynamic wrinkles. Each muscle contraction and facial movement causes the skin to bunch together forming lines between the bulk of the muscle. Dynamic lines include the “frown” lines between your eyebrows, “crows feet” on either side of your eyes, and horizontal forehead lines. Once you see fine lines forming the damage is being done. It is time to seriously think about a sprinkle of Botox. The longer you wait because you “aren’t old enough for Botox”, the harder and more expensive it is going to be to improve those lines.

Contrary to popular belief, well placed Botox will not make you look fake or frozen. In fact, well placed Botox will result in barely perceptible decrease in expressions and amazing relaxation of the dynamic lines of your face. Your friends and family won’t be asking if you got Botox, they will be asking you if you got your hair done or what makeup or moisturizer you are using. There is a high likelihood your friend that “only washes her face with water and uses Ponds Cold Cream to moisturize” is sitting in our Botox cosmetic chair as we speak.

But – you may say – Botox is too expensive – WRONG. You can achieve a full face refreshed, natural result from Botox for about 35 – 40 units which will last 3-4 months. For $25 a week, you can have less lines on your face and look more refreshed and radiant. Remember, the deeper the line, the more Botox will be needed; therefore increased cost if you decide to wait until you are “old enough”.

There is no magic age to start but remember, “an ounce of prevention is worth a pound of cure”. Why is it no one bats an eye when you start eating healthier, exercising, reading more, drinking more water, highlighting your hair and getting a fun haircut, or getting a well-deserved pedicure but Botox and filler has to be such a taboo subject? Well it is 2021 and it doesn’t have to be taboo anymore if we don’t let it.

Like all great things in life, repetition, consistency and maintenance is key – whether it is exercising, relationships, eating right, parenting or keeping up with never ending laundry and housework.  Your mind and your body and your health are your greatest gift and it’s time you start investing in all three if you aren’t already. You can invest in your mind by reading, meditating, praying, learning a new language to name a few. You can invest in your body and your health by eating clean, moving your body, and stopping (or at least decreasing frequency of) habits like smoking or fast food.  Let’s take this a step further and discuss investing in your skin!

You owe it to yourself (and your skin) to set aside a couple minutes in the morning and before bed to cleanse, treat, and moisturize. However, walking the aisle in the personal care/beauty section of a store is overwhelming. There are so many options for cleansing, treating and moisturizing where do you start? Let’s start at the basics: cleanse, treat, moisturize and prevent.

This chart below can be printed, taken to the store as your shopping list and taped to your bathroom mirror until it becomes second nature. There are two columns – one for medical grade skincare and one for drugstore finds. Medical grade skincare is of higher potency and active ingredients and therefore is typically a bit more of an investment. If you have been trying drugstore products and not seeing results, it is probably time to run to your dermatologist’s office to pick up something a little more potent.

Good habits start young and in conclusion we will touch on adolescent issues or teenage skincare. Starting a good skincare routine early in life can make it a habit that lasts into adulthood. Good, consistent skin care can help prevent or control acne, prevent acne scarring and prevent sun damage and pigmentation.  Acne scars, sun damage and pigmentation can be forever or extremely expensive to improve (note: we did not use the word cure or fix). What doesn’t bother a teen now, might when they get a little older or in adulthood. A good teenage skincare regimen doesn’t have to be complex or expensive, but it does have to be consistent. Waking up 2 minutes early each day to ensure at least a 30 second cleanse and moisturizer with sunscreen is key to good habits and clearer skin. Trying to tell a teenager this is difficult but if you buy them, number them in order of use or tape instructions to their mirror, there is a good chance they will use them. You can lead a horse to water but you can’t make him drink is true, but if you make it easy and put it in clear line of sight, likelihood increases.

There is no more profitable investment than investing in yourself and an investment in yourself pays the highest dividends. If there is anything we at MidState can do to help your skin goals please give us a call!

Featured Products

Lipid Replacing Cleansing Gel

This revitalizing cleanser effectively removes dirt, makeup and excess lipids without damaging the skin barrier.

BENEFITS

  • Non-irritating foaming gel cleanser
  • Slightly acidic pH
  • Excellent professional cleanser that works well prior to microdermabrasion, chemical peeling, enzyme or oxygen treatments

 

 

 Micro-Exfoliating Honey Cleanser

Micro-beads of natural beeswax gently cleanse and exfoliate, while absorbing excess oil. Leaves all skin types feeling fresh and revitalized.

BENEFITS

  • Gently exfoliates, leaving the skin silky and smooth
  • Naturally oil absorbing and hydrating at the same time
  • Fragrance-free and sulfate-free
  • Gentle enough to be used twice daily

Allison Weber, APRN-CThe Cost of Keeping Up

By Allison Weber- APRN-C & MidState Skin Institute

The cost of treatment will always outweigh the cost of prevention. This holds especially true when it comes to your skin. Once a skin condition has set in, it’s exponentially harder to get rid of. Let’s take a look at some of the costs to prevent these skin issues vs. the cost of treatment.

Melasma and sun spots are common in our beautiful sunshine state. Typically found on the cheeks, nose, forehead and chin, melasma or sun spots are dark grey/brown patches. Prevention starts early, and it’s simple- sunscreen! Choosing a broadband, SPF 30 or higher product with zinc/titanium dioxide and applying it every 2 hours might be the easiest prevention tip we have. Allison Weber, APRN-C at MidState, says her favorite SPF is EltaMD. Treatment for melasma/sun spots can take months, and involve a plethora of options such as prescription topical hydroquinone ($10-100), topical retinoids ($50+), cosmetic peels ($90+), Vitamin C ($20+) and tranexamic acid ($20+). It’s important to note, some forms of melasma are hormonal and may not be preventable.

Wrinkles are a natural part of aging; we can’t change our DNA. However, there are many factors that can speed up aging skin such as excessive exposure to UV rays, smoking, dehydration and pollutants. Prevention of wrinkles should involve daily sunscreen ($10+), a consistent skincare routine ($20-100) and a healthy lifestyle. Additionally, starting preventative neurotoxins like Botox early on can lessen the amount of neurotoxin that’s needed ($100+), and also the number of areas to be treated. Late treatment of wrinkles can almost double the cost of your skin care regime. Not to mention, not keeping up with your health may result in more than just a trip to the dermatologist. Treatment of deep, set in lines could require more product resulting in higher costs ($300+) and additional treatments.

Dyshidrotic eczema is a form of eczema that shows up on the hands or feet, and causes tiny, intensely itchy blisters. For most people, having dyshidrotic eczema falls somewhere between having it once (3-4 weeks) and living with the chronic, debilitating condition. Moisturizer plays a key role in helping your skin heal, and stay healthy. Dermatologists recommend you use a fragrance-free ointment or cream (not lotion) to help prevent skin from reaching the point of severe irritation. A MidState favorite is CeraVe Moisturizing Cream that can be found at your local drug store for $10-15. Alternatively, treating dyshidrotic eczema can involve prescription topical treatments, multiple visits to the dermatologist and steroid injections. Depending on insurance and severity you could be looking at months of treatment and $100’s.
Consistency is key. Keeping up with your skin care is health care. Once a day care adds up to weekly, monthly and yearly benefits. Conversely, neglecting your skin can add up as well. Put the time into yourself, it’s a good return on investment.

Splurge Worthy-
1. Dr. Brandt- No More Baggage
2. Neocutis- Bio Cream
3. Neocutis- Lumiere
4. EltaMD- Barrier Renewal Complex
5. EltaMD- So Silky Hand Cream
6. EltaMD- UV Broadband SPF
Drug Store Finds
1. Yes to Tea Tree- Scalp Relief
2. CeraVe- Vitamin C Serum
3. Vichy- Mineral 89
4. Aveeno- Repairing Cica Hand Mask
5. Burts Bees- Lip Scrub
6. Neutrogena- Hydro Boost Water Gel
7. Neutrogena- Rapid Wrinkle Repair

2020 was definitely a memorable year. As a society, we navigated a crippling pandemic, social isolation, divisive politics, and riots for racial justice. Some of us lost love ones, some of us lost our livelihood, some of us lost our hope. We could dwell on all that negativity or, we could be thankful we are a strong, resilient, loving species and approach 2021 with a refreshed attitude and the confidence to face what tomorrow brings us without fear. That’s what I’m choosing.

Regarding skin, this is a great time of year to start undoing all the damage we did from the summer. Procedures like chemical peels and IPL that we use to treat sunspots require sun avoidance for a couple of weeks which makes these cold winter months ideal timing for scheduling that. Also, if you haven’t already lasered unwanted hair on your body, getting started now, will ensure soft smooth hairless skin in time for summer.

As we look to set resolutions, make goals, and dream big, I encourage you to focus on health, energy and happiness. Be well my friends!

Happy New Year!

 

WINTER AESTHETICS
Did you know there’s a season for certain aesthetics procedures?

Despite the fact we’re here in sunny Florida, sweater weather is upon us! The winter months are a great time for procedures that have a little longer downtime, and the perfect opportunity to hibernate and recover. Let’s look at a few.

IPL- Intense Pulse Light is used to treat a myriad of issues such as wrinkles, age and sun spots, birthmarks, varicose veins, rosacea and so much more! Since it’s recommended to avoid sunlight, these winter months are perfect to start your treatments.

Laser Hair Removal- Laser hair removal is best done when you will have no sun exposure, because it reduces the risk of pigmentation. Treatment can take multiple sessions, so doing it in the winter months when the beach is less tempting is the ideal time.

Sclerotherapy- Treating spider and varicose veins can be hot, not that way! Some patient require compression socks and hosiery, so it’s not always preferable to start these when the temperatures are hitting triple digits. “Pants” season is a convenient excuse, and can allow you plenty of time to heal without anyone ever knowing.

Chemical Peels- Limiting sun exposure after a chemical peel is a crucial part of healing. Peels can make your fresh, baby smooth skin more susceptible to burn and that’s why these chillier months are called peel season.

Ready to book? Call Anna now! 352-512-0092