Dr María Victoria de Gálvez and Dr Norberto López, members of the Dermatology Team at Vithas Xanit International Hospital, led by Dr Enrique Herrera Acosta, talk to us today about the characteristics and properties that sunscreen must have to really protect us. They also explain how to apply sunscreen.

To begin with, we need to know that there are three types of ultraviolet radiation, A, B and C, but only UVA and UVB rays reach Earth because UVC rays are filtered out by the ozone layer. UVA rays are active all year round and affect skin ageing and solar allergies. UVB rays reach the Earth’s surface in less quantity but are more energetic and are active especially in summer. They are primarily responsible for sunburn.

What really makes a cream protect us from solar radiation?

• Physical and chemical filters: Sunscreens have physical filters and chemical filters. Physical filters contain particles that act as blockage of solar radiation. Chemical filters contain substances capable of absorbing solar radiation in the UV strip.
• SPF: SPF is the ability of a sunscreen to decrease erythema caused by exposure to the sun. It is a number that indicates how long we can expose our skin without getting sunburned with UV rays.

What factors should we consider when choosing a sunscreen?

As a basic rule, it is necessary to take into account the SPF enclosed on the packaging, photoprotection against UV rays and water resistance, especially at children’s age. It should be borne in mind that in patients with pathologies such as photodermatosis or skin cancer, it is necessary to ensure a very high photoprotection.

Tips for properly using sunscreen

• The most important thing is that we should never expose ourselves to the sun without any protection because even when it seems to us that there is no evident danger from the sun, ultraviolet rays always reach our skin.
• We must avoid direct exposure to the sun, mainly during midday and especially in summer.
• The sun cream blocks UV from the moment it is applied and stabilises after 5-10 minutes. So the general recommendation would be to apply it 5-10 minutes before exposure to the sun and repeat it at least every two hours, or more often if we have been swimming or had the sunscreen absorbed with our clothes.
• Sunscreens have their expiration day and should be changed every year, as they lose properties and we may not be really protected and may suffer from sunburns or skin allergies.

Children, elderly and pregnant women are recommended to limit exposure to the sun. In the case of children and the elderly, the skin is more sensitive. In the case of pregnant women, hormonal changes cause them to be at greater risk of sunburns.

Summer is here, together with insect bites. It might be due to the heat or because in summer we do spend more time outdoors, nevertheless, stings by mosquitoes, spiders, ticks, or wasps are the most common during the summer months.

Most insect bites and stings are not dangerous, and they only cause slight discomforts such as itching or stinging, however, by over-scratching the affected areas, it is not uncommon to make such injuries worse.

Dr Álvaro Barranquero, from the Dermatology Department at Vithas Xanit International Hospital, led by Dr Enrique Herrera Acosta, explains what the most common bites and stings are and how we should treat them.

The most important thing is prevention

There is no secret method for insects not to bite us, however, we can take some steps to avoid stings, both when indoors and outdoors.

At home, we should keep the doors and windows closed as long as possible and, if we leave them open, try to have the light switched off or at least dimmed, as strong light attracts most insects. It is advisable to keep the food stored in containers because it can also attract insects if left out in the open.

As far as the outdoors is concerned, we can protect ourselves with insect repellents and avoid areas and times of the day where they can reproduce more. We should also apply less perfume and wear clothes with neutral and less striking colours.

What should we do if we’ve already been stung

If we get stung by an insect even though we have applied the repellent, it is very important to avoid scratching. The best thing is to clean the area and apply an ice pack to reduce swelling, which also acts as an analgesic.

It is very likely that insect bites and stings mainly happen while we are on holiday, so for that reason, we should avoid being in the water for longer periods, especially in swimming pools, since for the cleaning and disinfection of the same products are used that can worsen our injury, increasing local symptoms.

When to see a doctor

The greatest risk of an insect bite or sting is the allergic reaction. It is considered serious and worrying when we have difficulty breathing or swelling of the mouth or throat.

If after the above measures the symptoms persist or get worse, we have a generalised malaise or suffer an allergic reaction, we should go to a doctor at once.

Laser hair removal consists of the application of light focused on the dark pigmentation of the hair, transforming it into heat. This heat reaches the hair root destroying it and preventing the hair from growing again. There are different methods of laser hair removal. Today, from the Vithas Xanit Aesthetic Dermatology Department, led by Dr Enrique Herrera Acosta, we review some of the most common methods and clarify some frequent doubts about this type of hair removal.

The existing methods of laser hair removal

The best laser hair removal method is that using a wavelength between 700 and 1200 nanometers ensuring that the skin will not suffer any damage during exposure. The available options are: the Alexandrite laser for medium-dark skin and a very fine, dark hair or short in length; the Diode laser, recommended for dark skin with dark hair; the Soprano laser, which can be used on tanned skin safely, although it requires a very precise technique for its use, and the Neodymio-Yag laser, which has the great advantage of adapting to all skin types, it is very safe and suitable for dark and deep hair.

Difficult areas

Any body area with enough hair is susceptible to laser epilation (legs, groin, armpits, arms, back, face, etc.). Laser hair removal differs between men and women, given that men have a more substantial amount of hair and much thicker than women. However, in matters of pain, the sensitive areas are usually the same.

• Moustache and beard: In reality, all areas of the face are the most painful and cause the most discomfort to those who undergo laser hair removal. The reason lies in the degree of skin and nerve sensitivity of this zone.
• Nipples: This area is often popular, above all, by men. Being an internal area, which practically is not exposed to the sun and is always covered by clothing, it is much more sensitive and delicate than the rest of the chest.
• Perianal area: This area is highly sensitive due to its internal nature. The intimate zone, in general, is very sensitive to the laser since it has virtually no contact with the outside and has many nerve endings.
• Neck: Although a priori does not seem like it, is also very sensitive to laser. The reason lies in its nerve endings and skin sensitivity.
• Labia and pubic area: The female genital area is also susceptible to laser hair removal, not only because of its nerve endings but also because of the darkness of the skin and the amount of hair that populates it.
• Inner thigh zone: This zone is also very delicate, not only for men but also for women. Normally, the hair in this area is removed more quickly, as it is not very strong, although its sensitivity is still high.
• Toes: Toes, due to their nerve endings, are characterised by being the most sensitive zone of the feet of men and women.
• Knees: Knees are also another critical area of the legs because although it may not seem, this area has many nerve endings. Apart from these areas, there are many individuals with special cutaneous sensitivity and skin ticklishness.

Differences between laser hair removal and Intense Pulsed Light (IPL)

Both are light sources but with different fluencies and different wavelength. Each laser has been manufactured to perform a specific treatment (e.g. epilation) and specifically IPL is a very useful tool with various uses in dermatology, but in some epilations, it is not as effective as the laser that is specifically manufactured to perform the same treatment.

The minimum sessions required to remove hair

It depends on the area, but the average number of sessions is between 6 and 8. The areas that are best epilated are armpits, groin and legs, achieving more than 85% of less superficial hair in three or four spaced sessions. This is because the total density of hair to be removed is stable and, under normal physiological conditions, the woman does not produce new hair in these areas.

Atopic dermatitis is a common skin condition, especially in paediatrics, currently affecting almost 20% of children. Although it’s symptoms usually disappear as the patient gets older, there are also adults affected by this pathology. Today, Dr Enrique Herrera Acosta, explains what atopic dermatitis is and offers us some practical advice on its treatment, prevention and how to act when faced with this condition.

What is atopic dermatitis?

It is a chronic skin pathology that causes itching and inflammation of the affected areas and gives rise to eczema of different consideration, which, also, leads to other lesions as a result of scratching. After a while, it can be translated into thickening and chronic dryness of the skin. It also psychologically affects the patient, with increased irritability, nervousness and difficulties in having adequate physical rest. It is, therefore, a significant problem for the quality of life of those who suffer it.

What are its main causes?

It is mainly a genetic disease, with the patients showing an individual predisposition to it, meaning they often have a family history of atopic dermatitis. However, whether the genetic factor is triggered or not depends on some external factors, such as very cold and dry environmental conditions. The existence of food or textile allergies further aggravates the situation.

Who does it affect? Does it affect everyone equally?

The initial outbreaks usually appear in the first months of life. Almost 20 per cent of children suffer from it. It is usually diagnosed in childhood and in most cases, tends to disappear as the patient is approaching adulthood; however, there are also reported instances of debutant adults with atopic dermatitis.

Is there a way to prevent atopic dermatitis?

There is no cure, nor unique treatment. However, the effectiveness of preventive measures and good personal care of atopic skin is proven. The personalised diagnosis by a dermatologist is essential, so when outbreaks or significant lesions occur, the patient can receive the appropriate treatment and specific pharmacological prescription with the correct dosage.

What treatments or recommendations would you give to prevent its occurrence?

Indoor places with dry air should be avoided by those suffering from atopic dermatitis. That is why it is important to maintain proper hydration of the skin. Atopic dermatitis entails a weakened skin barrier, which is why the lack of moisture in the air favours the extreme dryness of the skin, which tends to crack and increases the likelihood of eczema and skin lesions typical of the disease.

Too low temperatures are also not good, because it also reduces hydration, reduces the generation of skin fat and further weakens such vulnerable skin. Cold also increases the feeling of itching, the patient scratches more, and secondary injuries worsen.

People who suffer from atopic dermatitis should wear 100% cotton garments, avoid sudden changes in temperature and use specific hygiene products, which the dermatologist recommends in each case.

The showers or baths can not be very long and the water should be warm. The shower gel should be mild, it is also advised to use shower oils. Do not exfoliate or use abrasive products. The skin should be dried without rubbing it with the towel, rather pat drying it.

Another thing to bear on mind is, as silly as it might seem, to keep your nails short and trimmed; the idea is to avoid scratching at all cost, but sometimes it happens unconsciously, for example, while you sleep, and the shorter the nails are, the less aggression will be produced over the affected area.

How should atopic skin be treated?

Using ointments or creams with corticosteroids is the general treatment in cases of mild-moderate outbreaks. As for maintenance and topical corticosteroid creams, there are inhibitors of Calcineurin, Tacrolimus and Pimecrolimus, which dermatologists use extensively during in-between outbreak periods.

When the extent of eczema is considerable, treatment resorts to cycles of oral corticosteroids. If the patient requires several cycles per year or stops responding to corticosteroids, it is necessary to consider choosing immunomodulatory drugs, other than corticosteroids, such as cyclosporine, mofetil mycophenolate, azathioprine, methotrexate…

Currently, there are also very encouraging results with biological drugs, such as Dupilumab, Omalizumab or Ustekinumab, which are used for other skin pathologies and could be effective in patients with severe atopic dermatitis.

What are the differences with other types of dermatitis, such as seborrheic or contact dermatitis?

Seborrheic dermatitis – is a skin disease also with a genetic predisposition, but can also be caused by fungi or excess of sebaceous glands. The lesions appear on the scalp and face, with noticeable redness and flaking. This fact makes a big difference from atopic dermatitis which can affect the whole body: the face, the flexion areas of the neck, arms and legs, meaning the folds of elbows and knees, and, in adults, damage appears in almost any area of the body.

Contact dermatitis. It is the skin’s response to contact with a particular substance, whether in food, textile or object… It does not have to be an allergy, but it can be a clue that there is an allergy.

Now in summer, what special recommendations should be given during hot months?

First of all plenty of moisturising, the more the better, but not over the areas affected by an outbreak of dermatitis. Moisturising is a preventive measure, to avoid irritations. When there are outbreaks, skincare will depend on the specific recommendations of the dermatologist.

When it comes to showers and baths, the recommendation is to do it in moderation. They should not be too long, in very cold or very hot waters.

Sun exposure is often a good ally in the treatment of eczema, so we sometimes use artificial narrowband ultraviolet radiation to control outbreaks. Still, always in moderation and without getting burned.

On the other hand, during outbreaks, you have to be careful with swimming pools because chlorine dries the skin very much, and for that reason, it is necessary to rinse your skin well after bathing — it is a good recommendation for everyone, but much more for people with atopic dermatitis. On the contrary, seawater is recommended because it enhances the beneficial effects of the sun.

Can atopic dermatitis be cured?

As it is a genetic disease, the answer is no. The medication can alleviate symptoms, depending on the severity of the cases. However, symptoms can disappear by itself with the progress of each individual, or attenuate with time, but there is no treatment to cure it.

There are a lot of questions when it comes to laser hair removal, either due to lack of information or because of some particularities that each case entails. To shed some light on the subject, our specialists have collected the most frequently asked questions:

1. Is there any guarantee that the treatment will be successful?

Once the specialist studies the type of hair and decides on an adequate laser, that will be the most effective and durable treatment available. It must be clear, however, that this is an almost definitive, but not entirely, epilating method. With laser hair treatment, most hair is removed, although in certain areas it results in a much lower density and some hair may remain. Besides, over time, it may be necessary to repeat the treatment, which depends on each case.

2. Is it true that winter is the best time for laser hair removal? – Why?

It’s not really a matter of season as such but of sun exposure. Photo-epilation can be performed throughout the year, as long as sun exposure is avoided before and after treatment. Laser treatment can not be performed on recently tanned skin due to increased risk of burns. On the other hand, nowadays there are types of laser such as Diode or Neodymium Yag which are prepared to epilate any skin type, and not mostly brunettes as up to know, but even the black skin, with maximum safety and guarantee, although it is always advisable not to sunbathe 2-4 weeks before the treatment.

3. How can hair colour influence treatment?

Hair colour and thickness are the most important factors for the effectiveness of laser hair removal. The laser targets the pigment (melanin) that exists in the hair and which, under normal conditions, is in higher concentration than in the surrounding tissues, so it is very important to assess the melanin charge of the patient’s hair correctly. The higher the concentration of melanin is (brown melanin), the greater is the ability to heat the follicular structures. Black or dark brown hair has a high pigment concentration and therefore absorbs energy better and is destroyed more easily than light hair. Fine hair with black or brown colour may be laser epilated, although it may require a greater number of sessions due to its lower melanin content. If we are dealing with a very blond or white hair, it cannot be laser-treated because it lacks melanin.

4. How do you treat areas with tattoos or skin moles?

Regarding laser hair removal on tattooed skin, the short answer is that it cannot be done. To understand why, you must first understand how the treatment works: the laser does not target the real hair, but the pigment in the hair. Therefore, if the skin is tattooed, then the laser will also attack the pigment of the tattoo.

The laser will not only ruin the tattoo, but also cause a considerable amount of pain. When the pigment hits against the tattoo, it can cause severe burns or blisters.

If it is a very small tattoo (letters, symbols, etc) or polka dots, it is possible to paint them with a white pencil in such a way that it does not absorb the light and therefore the skin is not damaged.

5. There is a widespread belief that getting facial hair epilated brings long-term face spots. What is the truth?

Laser hair treatment, in expert hands, is a safe method for hair removal without damaging the skin, although there are always risks associated, such as burns and temporary hyperpigmentation of the skin (spots), However, these are minimized as long as there is a supervision of a specialist in aesthetics, who determines all the parameters that a laser requires to work safely, based on the characteristics of the patient’s skin.

6. What if I am under-age and want to undergo laser hair treatment?

The treatment is recommended for those over the age of 18 since there is greater hormonal stability, which allows better results in the long term. However, the procedure may be performed on under-age patients providing that they have the consent of their parents and are aware that they may need more sessions to achieve the desired result as the hair does not appear at the same time in all young people. Indeed, there is a range between the ages of 10 and 15 during which the hair is showing. Also, at the same age, one girl can be completely hairless, and another can have it fully developed. The treatment is not possible on all desired areas and in all people who would like to undergo the laser hair removal. The armpits and some areas of the legs usually have a good result if the hair has the right thickness; however, in other areas, it is not advisable to start early. However, with proper protocol and experience, laser hair removal in girls and adolescents is possible, the result is good and avoids the drawbacks of waxing and razor-shaving. Moreover, once they have started with the right laser treatment, there is no need to epilate using other methods and can stay 2-3 months without having to epilate because there is no hair.

And to finish this list of questions, we attach a statistical data that causes great curiosity.

7. What are the areas that are mostly treated by men? What about women?

Men often request laser treatment on the back, shoulders, chest, abdomen and cheekbones. Areas with more pronounced hair density are always more uncomfortable. However, other areas such as the legs, neck, arms, buttocks or hands are also increasingly more requested.

As for women, at present, the most treated areas are the armpits, the groin and the legs. Be informed about these pieces of advice before your laser hair removal and the most sensitive areas to be treated.

Are you thinking about having a laser hair removal treatment? We are aware that there are many doubts and uncertainties in this regard, so today we have asked Dr Monica Garcia Soto, from Vithas Xanit Aesthetic Dermatology Department, what pieces of practical advice we should bear in mind before and after laser hair removal.

Tips from our specialists, before and after laser hair removal treatment

BEFORE laser hair removal, you should avoid getting tanned or exposed to UV rays at least one month before treatment. This is due to the fact that the laser uses melanin from the hair as a conductor, and if the skin has melanin activated, there is a risk of burns. However, this is not necessary if using Diode Laser Depilatory System.

Also, you should not pluck your hair with tweezers or get it waxed, or use any other epilating method that pulls off the hair from the root. We have to make sure that for the first session you have not been epilated or shaved at all for at least 4 days before the session. Subsequently, you can shave your hair, but only with a razor, avoiding any other method that eliminates the hair directly from the root.

You must attend laser sessions with completely clean skin, without creams, self-tanning, deodorants, perfumes or makeup.

It is important to let us know if you are pregnant, if you are taking any medications, especially anti-contraceptive pills, hormonal treatments, acne treatment or any other. There are many drugs with photosensitive effects, so before starting a laser hair removal session it is necessary to indicate what medication you are on if any.

Any cream containing retinol or glycolic acid should also be discontinued at least 5 days before each laser session.

No hair bleaching should be done at least 4 or 5 days before each session.

It is also important to report whether you have or have had cold sores in the days prior to treatment.

It is necessary to moisturise the skin regularly.

AFTER laser hair removal treatment you should use restorative creams if there is any irritation on the skin, and you should be moisturising your skin for 3 or 4 days in any case. Avoid the use of alcohol-containing deodorants if the armpits have been treated. Avoid sun exposure at least 7 days after undergoing laser hair removal. It is recommended to use total-block sunscreens when sunbathing again. Hair should fall out within days of treatment and can be shaved with a razor only, never with wax or hair epilators.

It is advisable to avoid wearing too tight clothing over the treated areas, at least for about 3 days after treatment. It is also not advisable to apply heat to the treated area, have excessively hot showers, saunas, hot tubs and the like for 3 or 4 days after treatment.

After facial hair removal, you should avoid applying make-up on the area for a couple of days.

The waxed area should not be scratched or overtouched. Washing should be done with neutral soap and warm water, without rubbing too much to avoid irritations. Finally, you have to maintain constant and regular hydration of the treated area. This habit helps with irritation and discomfort that may appear, as well as to prepare the skin for the following sessions.

New advances in technology have always been a powerful medical tool, now one of these, the mole mapping technique, is using digital photography to assist with diagnosis. The mole map covers the patient’s total surface area of the skin enabling doctors to examine and log skin abnormalities (shape, size, location and colour) in detail. Every detail matters, a digital map of the patient’s body is obtained, which is then periodically repeated and stored, enabling dermatologists to analyse and contrast changes in blemishes, moles and other skin lesions, constantly alert to any alterations.

Benefits of body mole mapping

Using the test the dermatologist is able to obtain an accurate and complete map of the skin, he/she can then periodically and systemically review anything which requires particular attention, analysing and contrasting any variations that occur. This is advantageous for the patient since this analysis prevents unnecessary biopsies or excision of benign lesions and, in addition, facilitates the early detection and treatment of malignant lesions or melanomas, offering a higher recovery rate.

This method also makes it easier to discover moles in areas which are difficult for the doctor or patient to see, such as the scalp, behind the ears or on the back, etc.

Am I able to have a body mole map?

If you are wondering whether a mole map is appropriate for you, please note that it is suitable for everyone, but it is particularly indicated for people with atypical skin lesions, multiple moles or a family history of skin cancer. It is a simple and painless test with high quality photographs taken of skin lesions all over the body. The test is repeated after a reasonable amount of time with overlapping of the images to detect any changes, these are subsequently given to our specialists for study and treatment.

A dermatologist is responsible for planning the mole map for each patient. Generally, an annual mole map is recommended, but in some particularly sensitive cases, it may be necessary every 6 or even every 3 months.

You can depend on Vithas Xanit International Hospital’s Dermatology Department to resolve any queries you may have, please request your appointment online.

The sun, the heat, the beach, together the combination can have dramatic effects on the body. For this reason we need to take special care of our skin during summer, the time of year when we are encouraged to spend most of our time outdoors.

Below Dr Enrique Herrera Acosta, Head of the Dermatology Department at Vithas Xanit Hospital, gives us a few tips.

Foods which help to protect the skin

There is no doubt that a varied and balanced diet, based on fresh, seasonable produce, including vegetables, fruit and fish, helps to keep the body strong and healthy and therefore, also contributes to a healthy skin. Drinking plenty of water is essential.

Swimming pools and beaches, how can they affect the skin?

Skin care in summer is vitally important at the beach or at the pool, sunscreen is a priority:

• It should be applied 30 minutes before leaving the house and renewed every two hours afterwards, it is also necessary on cloudy days.
• It is best to avoid sun exposure between 12 midday and 4 in the afternoon, and avoid spending hours at a time in the sun. Every precaution should be taken with children and the elderly, or those with very sensitive skin.

Regarding the pool, some of the products used to maintain the standard of swimming pool water can cause skin reactions in certain people, it is important to consult a dermatologist if this occurs.

Taking note of the appearance of blemishes or moles is essential, observing for worrying signs: asymmetry, changes in the edges, colour, diameter, growth… If you notice changes in shape or colour, or have any discomfort or pain, you should make an appointment with a Dermatologist immediately; there is no good reason to wait, but every reason to act as soon as possible.

The importance of sleep on the skin during summer

Whilst we are sleeping, skin regenerates and rests after spending the day dealing with UV radiation, air conditioning, pollution and other daily “challenges.” As a general recommendation at least 7 hours’ sleep is advisable and whilst on the theme of skin care, it is important to sleep with the skin clean and moisturised. There are many products, creams, serum, tonics which can be used, but the special characteristics of each skin type need be taken into account alongside recommendations from Aesthetic Dermatology Specialists.

How can we fight the sun?

As well as never forgetting sunscreen, there is a greater need for skin protection measures such as hats, caps, sunglasses and appropriate clothing in summer, fundamental for improved UV protection.

Remember that not all clothes offer the same protection against the effects of the sun. Shirts and other fine materials may be made of a more breathable fabric, but may not provide enough protection. Ideally at times of high exposure, specifically designed tops or dark coloured, cotton shirts (such as T-shirts or polos) should be worn.

In a nutshell: sun yes, but in summer (especially) skin care as well. Don’t forget!!

Today we are going to concentrate on a condition which affects 2% of the Spanish population: psoriasis.

Psoriasis is a chronic autoimmune disease, meaning it results from a malfunction of the body’s immune system. It is not contagious and can appear on the skin throughout the body. It appears in the form of raised red plaques, with a covering of dead, white skin cells, which are often painful and can cause itching.

Not only does this condition affect the skin, it can also affect the joints and is associated with a greater risk of cardiovascular disease. 

Although the cause is unknown, a significant hereditary component has been demonstrated. 40% of patients suffering from psoriasis have a first degree family member with psoriasis or psoriatic arthritis, this rises to 90% in the case of second degree family members. Other factors have also been identified, such as stress, trauma, infection and some medications. 

Psoriasis can worsen at certain times of the year, especially if exposed to atmospheres which dry the skin. The use of heaters when the cold weather arrives, or, spending time in places where winter is very dry can complicate the condition. During the summer time it can be beneficial to expose the skin to the sun, but not in the middle of the day and not for more than a quarter of an hour. As always, sunscreen is completely necessary at all times, sunburn is even more serious for skin affected by psoriasis. 

The results of psoriasis are not only physical. The psychological effects of this condition have been described in many studies, showing that 75% of patients seen with psoriasis suffer from insecurity, stress and anxiety as a result of their disease. 

However, every case is different therefore all patients with psoriasis should undergo a specific, individual assessment by a Dermatology Specialist.

In the Dermatology Unit at Vithas Xanit International Hospital, our specialists led by Dr. Enrique Herrera Acosta, tackle treatment of this condition using the most advanced technology available. Vithas Xanit Limonar have introduced the latest system, offering photochemotherapy with Psoralen-UVA and phototherapy with Narrowband UVB. Although currently psoriasis cannot be cured there are several treatments to control the condition with very satisfactory success rates depending on the type of patient. 

Dermatologists from Vithas Xanit International Hospital’s Dermatology Department, can help and advise you on how to deal with this condition to obtain optimal results.

Source of news: Clínica Dr. Herrera