Eczema 101 : Get the Facts

October is National Eczema Awareness Month so let’s spread awareness starting with some basic facts.

What is Eczema?

We asked our board certified dermatologist, Dr. Michelle Cihla. She explained, “eczema is a skin condition that causes the skin to become red, itchy and inflamed. It commonly appears as dry or scaly patches and can develop anywhere on your body. It isn’t contagious, but develops because of a combination of environmental triggers and genetics.”

FACT: Eczema is very common, with over 30 million Americans having some type of this skin condition.

What Are the Types of Eczema?

  1. Atopic dermatitis – This type is caused by a malfunction in the immune system and problems with the skin barrier.
  2. Contact dermatitis – When skin touches a known irritant and/or allergen, it can cause this type of eczema.
  3. Dyshidrotic eczema – Exposure to allergens causes this kind eczema, which presents itself as itchy blisters on the feet and hands.
  4. Hand eczema – This type is caused by a combination of genes, irritants and/or allergens.
  5. Lichen simplex chronicus – Too much scratching and rubbing lead to this type of eczema, which presents as thick, scaly patches on the skin.
  6. Nummular eczema/discoid eczema/nummular dermatitis – Allergens or very dry skin cause this kind of eczema to develop. It manifests as round lesions and can weep fluid. You will find this type of eczema most commonly in older populations.
  7. Seborrheic dermatitis –  This form of dermatitis appears as white or yellow flaky, greasy patches in places with more oil-producing glands. A combination of genetics, hormones and microorganisms on the skin all contribute to the development of this type of eczema. In addition,  “cradle cap” is the common name for this skin condition in infants.
  8. Stasis dermatitis – This kind of eczema occurs when poor circulation to the legs causes the veins to swell and leak fluid. As a result, swelling, skin redness, as well as itch may occur.

Treating Eczema – Get the Facts

Living with eczema can be an ongoing challenge, but the condition is manageable. This is largely due to the various treatment options that are now available. For example, your dermatologist may recommend: prescription topical medications, phototherapy and/or biologics. However, your dermatologist will consider your age and the severity of your case before making any recommendation.

According to Dr. Cihla,

“if you are affected by eczema it is best to know your triggers to avoid exposure. Be consistent with your treatment plans and develop a daily moisturizing regimen to help soothe dry skin.”

In conclusion, if you are struggling with eczema or other skin issues and don’t know where to turn, we can help. Our board certified experts are available at three convenient locations in Kentucky. Call a local dermatologist today!

Top Treatments for Excessive Sweating

As we discussed in The Science Behind Sweat, sweating is a necessary component of a proper functioning body. In some cases though, people can suffer from excessive sweating, also known as hyperhidrosis. According to Dr. Giacomo Maggiolino, board-certified dermatologist with Forefront Dermatology, “many people who have hyperhidrosis sweat from one or two areas of the body while the rest of the body remains dry. This excessive sweating commonly interferes with every day activities like turning a doorknob or using a computer. In severe conditions, the excess sweat can lead to skin infections.” There are treatment options available for those who suffer from excessive sweating:


Antiperspirants are considered the first line of treatment for excessive sweating because they are the least invasive and least expensive treatment option. The active ingredient in antiperspirants is commonly aluminum salts which reduce the amount of sweat released. Once an antiperspirant is applied to the skin, perspiration in the underarm grabs and dissolves the aluminum salts, pulling them into the pores and forming superficial plugs that are just below the surface of the skin. When your body senses that the sweat duct is plugged, a feedback mechanism stops the flow. The plugs can stay in place at least 24 hours and then are washed away over time. For best results, antiperspirants should be applied at night to allow enough time for this mechanism to work.

Antiperspirants are available either over-the-counter or by prescription from your local dermatologist. Over-the-counter antiperspirants are also now available in clinical strength that provides improved sweat reduction compared to traditional antiperspirants.  Over-the-counter antiperspirants have been shown to decrease sweat by 20 percent, while prescription antiperspirant can decrease sweat by 30 percent.

BOTOX® Injections

In 2005, the FDA approved BOTOX® for the treatment of underarm excessive sweating. It is a natural, purified protein that has the ability to temporarily block the secretion of the chemical responsible for triggering the activation of the body’s sweat glands. BOTOX® injections have been shown to decrease sweating by 82 to 87 percent and results can last between 4 and 12 months.


While the above treatments offer a temporary solution, a specialized treatment is now available to help permanently eliminate bothersome underarm sweat. miraDry® is the only noninvasive, FDA- cleared treatment that safely and permanently removes the sweat and odor glands in your underarms.

The miraDry® treatment is an hour long treatment that uses miraWave energy to targets and eliminate sweat and odor glands in your underarms. Once the glands are removed, they do not grow back. According to Dr. Maggiolino, “a common misconception is that you need the sweat glands in your underarms, but of the over 2 million sweat glands on your body, only 2 percent are located in your underarms. With the miraDry® treatment, you can expect to have an immediate and permanent solution to underarm sweat.” The treatment is very safe and effective, decreasing under arm sweating by 82 percent. Dr. Maggiolino added, “With a patient satisfaction rate of 98 percent, patients can live antiperspirants and deodorant free lives.”

Skin Struggles?

If you are struggling with excessive sweating or skin issues and don’t know where to turn, the skin health experts at Forefront Dermatology are ready to help.  To find the Forefront dermatologist nearest you, visit the locations page today.

The Science Behind Sweat

Sweat gets a bad rap. We call it smelly and it ruins our favorite white tees. But, the truth is we need to sweat.

How Does Sweating Work?

Your body is home to two types of sweat glands, eccrine and apocrine. Eccrine glands regulate the body’s temperature. Your body temperature can rise due to physical activity, stressful environments and external temperatures. As your body’s temperature rises, the nervous system stimulates the eccrine glands to release sweat, allowing it to cool the body down. Apocrine glands are mainly found in the underarms and groin. These particular glands produce bacteria causing body odor. This is why deodorant is put only under the arms instead of all over the body.

Why You Sweat So Much

On average we sweat about 1 liter per day, but most of it evaporates before we notice. Armpit sweat is the common concern, but it only accounts for 2 percent of our body’s perspiration. The average person has two to four million sweat glands throughout the body, but how much we sweat is determined by a variety of factors including gender, genetics, environment, age and fitness level.

If an individual weighs more, the amount of sweat is likely to be higher because the body must exert itself more to cool down. On the flip side, a fit person will start sweating earlier and easier. It may sound unlikely, but as someone becomes fit the body becomes more efficient at regulating the body’s temperature. When you start sweating earlier, the body can cool down faster allowing an individual to work out longer.

Skin Struggles?

If you are struggling with excess sweating or other skin issues and don’t know where to turn, the skin health experts at Forefront Dermatology are ready to help.  To find the Forefront dermatologist nearest you, visit the locations page today.

Treatment Options for Aging Skin

Aging happens. Skin starts looking dull, fine lines start showing up, dark spots appear. When you look in the mirror, if your reflection doesn’t match how you feel, it may be time to do something about it. Fortunately, with the advancements in cosmetic dermatology, it’s easier now than ever to get that glow back.

Many cosmetic treatments start at a reasonable price and can be done during a lunch break or a quick visit after work. According to Dr. Victoria Negrete, board-certified dermatologist with Forefront Dermatology and medical director for Excelin Medical Spa, “You would be very surprised the dramatic impact even small cosmetic tweaks can make to your appearance. I have patients tell me post-treatment their friends, family or co-workers have commented that they look refreshed or wonder if they just got back from vacation, never realizing a cosmetic treatment was involved.”

“I love my wrinkles,” said No One Ever

The array of treatments that fall under the category of cosmetic dermatology are abundant. There is the ability to treat a wide variety of issues that plague people today, including wrinkles, brown spots, dull dry skin and thinning lips. The most common issue heard from homes to office cubicles is wrinkles. “By lifting sagging skin and filling in wrinkles, the face will look less tired and have a softer and younger appearance,” according to Jennifer Erb, Certified Master Injector with Forefront Aesthetics. “The fastest way to do this is with injectable dermal fillers, such as Juvederm®. These work quite well to give significant improvement, have minimal downtime and cause very little discomfort.”

But I don’t like needles!

Not everyone is a huge fan of needles, and that’s completely understandable! There are alternative treatments available that avoid the use of needles but can still help you achieve your skin goals. Chemical peels are great, non-invasive options that help remove dull surface cells, improve fine lines, and reduce sunspots and discoloration. The result is an increase in collagen production and smoother, more radiant skin. There are multiple different strengths of chemical peels that range from surface level peels to deeper peels. A consultation with your provider will help determine which type of chemical peel will best target your needs.

Struggling with aging skin?

If you look in the mirror and your reflection doesn’t match how you feel, maybe now is the time to sit down with a cosmetic professional to determine how you can reach your goals. Everyone has beauty, but with cosmetic treatments you can enhance it. Find your nearest provider and schedule your anti-aging consultation today.

Quick Facts about Psoriasis

August is national psoriasis awareness month. Chances are if you or someone you know doesn’t suffer from psoriasis then you most likely do not know a lot about this skin condition.  While psoriasis isn’t contagious, awareness is:

125 Million – the number of people affected by psoriasis worldwide

7.5 Million – the number of people affected by psoriasis in the United States

Scaling, itching, thick red skin – the most common symptoms of psoriasis

10 to 30 – the percentage of psoriasis patients that experience arthritis symptoms as a result of their condition

Scalp, Knees, Elbows, Hands and Feet – the most common areas on the body where psoriasis occurs

15 to 35 – the average age range where people have their first psoriasis outbreak

60 – the percentage of people with psoriasis who reported their disease is a large problem in their everyday life

26 – the average number of work days missed in a year by a psoriasis patient as a result of their illness

10% – the likelihood of a child developing psoriasis if one of his or her parents is affected by it

50% – the likelihood of a child developing psoriasis if both parents are affected by it

0 – the number of cures for psoriasis

While psoriasis has no cure there is hope for a cure. Researchers are studying psoriasis now more than ever before. They now have a strong understanding of the genetic causes of psoriasis and how it affects the immune system. While there is no cure, there is an abundance of excellent treatment options to control or manage your psoriasis and its symptoms.

Skin Struggles?

If you are struggling with psoriasis or other skin issues and don’t know where to turn, the skin health experts at Forefront Dermatology are ready to help.  To find the Forefront dermatologist nearest you, visit the locations page today.


7 Common Face Washing Mistakes

Your daily skin care routine most likely starts and ends with washing your face. According to Dr. Victoria Negrete, board-certified dermatologist with Forefront Dermatology, “while cleansing seems like it should be the least complicated part of your skin routine, certain face washing habits can lead to numerous skin issues including irritation, oiliness and breakouts.” Here are the top 7 face washing mistakes and how to correct them:

1. You’re using the wrong product
The right cleanser should completely remove dirt, makeup and dead cells, but not be too harsh that it removes your skin’s natural oils and healthy cells. Choose a cleanser that is neither too gentle where you have to scrub multiple times nor too harsh where it leaves your skin red and dry.

2. You wash your skin too often
Generally, washing your skin once or twice a day is a good standard to follow. Any more than that will lead to irritated skin and usually an overproduction of oil. If your day involved no makeup, sunscreen or sweat you can skip the cleanser that night and just rinse your face with water. Giving your skin a break from time to time is healthy.

3. You’re washing with the wrong water temperature
There is a skin myth out there that says hot water opens pores while cold water closes them. The truth is that pores don’t have the ability to open and close. Lukewarm water is the best for gently cleansing your skin. Too hot of water can lead to over dry skin.

4. You exfoliate more than you should
While exfoliation is a healthy practice to remove dead skin cells, the key is to not exfoliate too often. Exfoliating a maximum of two times a week is plenty to remove dead skin cells, but not irritate your skin.

5. You skimp on the face rinse
In a world where time is limited and moving too fast, it is easy to rinse too quickly. Skimping on the rinse can lead to residue build up – clogging pores and drying out the skin. The jawline, hairline and nose are common spots to get missed during rinsing.

6. You have poor towel habits
When drying off with a towel the key is to pat not rub. While rubbing is easier and soothing, it tugs and pulls on your skin putting your skin’s elastin at risk. It is also important to never share towels. Designate your own towel to prevent bacteria from spreading.

7. You aren’t sure when to moisturize
A common question is whether you should moisturize while your skin is wet or dry? To maximize absorption and help seal in moisturizer it is important to apply moisturizer immediately after cleansing while the skin is still damp.

Skin Struggles?
If you are struggling with skin issues and don’t know where to turn, the skin health experts at Forefront Dermatology are ready to help. To find the Forefront dermatologist nearest you, visit the locations page today.

Top 3 Treatments to Reverse UV Damage

Whether you were a tanning bed user in the past or spent years slacking on sunscreen application, you may be affected by sun damaged skin. According to Dr. Abigail Donnelly, board-certified dermatologist with Forefront Dermatology, “sun damage spots on the skin are flat brown spots directly caused by sun exposure.” Any UV ray from the sun can darken existing sunspots including the harmful radiation that comes through windows or passes through cloud cover. Dr. Donnelly added, “most everyone will eventually develop sunspots, or lentigines, on their skin. Individuals with fair skin or extensive sun exposure are more prone to developing them earlier on in life.”

Sunspots commonly show up on the face, neck or chest and on the back of your hands – the areas that get the most lifetime sun exposure. While sunspots are usually harmless, they can be an unwanted cosmetic appearance. Luckily, there are cosmetic treatments available to help minimize or eliminate sunspots over time. The best results occur when you combine one of the following procedures with a comprehensive skin care routine.

Microdermabrasion involves a controlled skin exfoliation that, like removing dust build-up in your house, removes the build-up of dead skin cells. Microdermabrasion is commonly performed using salt crystals, aluminum sand, or a diamond surfaced wand. There is no down time or recovery period associated with microdermabrasion. The best results are obtained with regular treatments ideally done at four to eight week intervals, in combination with a proper skin care routine.

Chemical Peels
A chemical peel helps remove dull surface cells, improve fine lines, and reduce sunspots and discoloration. The result is an increase in collagen production and smoother, more radiant skin. There are multiple types of chemical peels that range from surface level peels to deeper peels. It is recommended to first consult with your provider to determine which peel is right for you.

Broad Band Light
Broad Band Light (BBL) is a non-invasive, no downtime treatment for sunspots and age spots. According to Dr. Donnelly, “BBL treatments are typically 30 minutes or less and use intense pulses of filtered light to target unwanted pigment in the skin. We select the spectrum of light that will best target the abnormal pigment, and leave healthy skin unharmed. The light is absorbed by the abnormal pigment and breaks it up, where it can then be absorbed by the body, or expelled from the surface in the form of tiny crusts. The associated heat stimulates skin tightening and collagen development. The process will restore your skin to its natural beauty, making it clearer, smoother, vibrant and younger looking.” Depending on the severity and amount of sunspots, BBL should be performed in a series of three to six treatments, resulting in 80 to 95 percent elimination of your sunspots.

Struggling with Sunspots?

If you struggle with your sunspots and want to minimize their appearance, the skin health experts at Forefront Dermatology are here to help. Find your nearest provider and schedule your sunspot consultation today.

Top 6 Rash-inducing Plants

A pleasant walk in your yard, a park or the woods can turn unpleasant quickly if you come in contact with rash-inducing plants and weeds. Learn to identify these plants so that you can eradicate or avoid them.

Poison Ivy
Poison Ivy
Poison Ivy

Poison ivy can be found across the entire United States. You can come into contact with it while hiking in the woods, but it grows virtually everywhere — roadsides, fences, weedy areas. Poison ivy leaves grow in clusters of three on vines that can grow up into trees and trail along the ground. The sap of the poison ivy plant is what causes an allergic reaction and can be found in all parts of the plant. Classic signs of poison ivy include swelling, redness, itching and painful blisters.

Poison Oak
Poison Oak
Poison Oak

Poison oak has nothing to do with the oak tree but is named for a similar leaf shape. Like poison ivy, poison oak is found throughout the United States, and it grows in forests and woods as well as in dry spots like sandy fields. In spring, the leaves can be red or green. During the summer, leaves are green and the plant grows berries while in fall the leaves turn red and orange. Poison oak rash is most likely to appear around your wrists, ankles and neck where the skin is thinner.

Poison Sumac
Poison Sumac
Poison Sumac

Poison sumac is actually a shrub. The stalk has a reddish hue, and its flower is yellow. Poison sumac likes wetter environments: it’s found near stream banks, ponds, and other wetlands. Like poison ivy and poison oak, poison sumac can cause contact dermatitis, and therefore the symptoms and treatment are the same.

Wood Nettle
Wood Nettle
Wood Nettle

The wood nettle, found at the bottom of streams, rivers, or forests, is actually an herb. The leaves, which are either purple or green, stand straight up and have hairs that stick straight out. These hairs are the stingers and if you come in contact with them they will penetrate your skin. Contact with wood nettle typically results in reddish, itchy welts.

Stinging Nettle
Stinging Nettle
Stinging Nettle

The stinging nettle is another herb with stinging hairs. It grows throughout the United States and can be found close to mountain and within, or near, forests. Resembling a tall weed, the stinging nettle has either pink or salmon-colored flowers that are shaped like hearts. The stinging hairs are found on the leaves and stems. Just as its name suggests, stinging nettles cause tingling, inflammation and pain.


While ragweed is a common cause for seasonal sinus allergies, what is not so widely known is that ragweed can also cause skin rashes if you touch them. These plants are often found in rural areas and open spaces that get plenty of sunlight. Coming in contact with ragweed may result in an itchy, painful rash that is usually comprised of small bumps and blisters.


Preventing these uncomfortable skin reactions involves some common sense steps.

  • When gardening, doing yard work or going for a hike, cover as much skin as you can. Wearing gardening gloves can prevent many plant materials from piercing your skin. Long pants and sleeves can also prevent accidental contact with low lying plants like the ones previously listed.
  • Avoid touching your face and eyes when working with outdoor plants.
  • Look before you take your next step especially if you are hiking in the woods.

In trouble?

If you have come in contact with any skin irritating plants wash the area thoroughly with plenty of running water and soap. Use an over-the-counter steroid cream and antihistamines, if needed, to control itching and irritation.  If these steps do not control your symptoms, or if symptoms worsen, the skin health experts at Forefront Dermatology are ready to help. To find the Forefront dermatologist nearest you, visit the locations page today.

Are you UV Smart?

July is UV Safety Awareness Month and our skin is the most UV-affected area on our body. While our skin spends every day protecting us against heat, dehydration, sunlight, injury and infection, some of us don’t consider protecting our skin to be of importance.

According to Dr. Abigail Donnelly, board-certified dermatologist with Forefront Dermatology, “Time and time again, research has proven that protecting our skin is key to preventing skin cancer. Harmful UV rays from both the sun and indoor tanning beds can cause many other complications besides skin cancer – including eye problems, a weakened immune system, accelerated aging and wrinkles.”

Protect Your Skin

There are simple, everyday steps you can take to protect your skin from the harmful effects of the sun’s UV rays.

  • Wear proper clothing that will protect your skin from the harmful UV rays. Protective clothing includes long-sleeved shirts and pants, a wide-brimmed hat that covers your face and neck, and UV-resistant sunglasses. UPF protective fabrics are now widely available and provide long-lasting sun protection that doesn’t sweat, rub or wash off. Remember, you can fall victim to sun damage on a cloudy day as well as in the winter, so dress accordingly year round.
  • Avoiding sunburns significantly decreases one’s lifetime risk of developing skin cancer. It is especially important to remember that just five blistering sunburns can increase a child’s risk of developing melanoma by 80 percent.
  • Stay out of the sun, if possible, when the sun’s UV rays are their strongest – 10am to 4pm. Use extra caution when near reflective surfaces, like water, snow, and sand. Even the windows of a building can reflect the damaging rays of the sun. The reflection from any of these common occurrences can increase your chance of sunburn, even if you’re in what you consider a shady spot.
  • Apply broad-spectrum sunscreen generously to cover all exposed skin. Broad-spectrum sunscreen protects against overexposure to UVA and UVB rays. Remember to reapply sunscreen throughout the day and after being in the water or sweating. Just because a sunscreen claims to be water resistant does not mean you can slack on reapplication. Water resistant sunscreen means the SPF within the sunscreen can be maintained for up to 40 minutes while swimming or sweating. It is important to dry off and reapply often for continued protection.

Protect Your Eyes

While the skin may be the body’s largest organ, your eyes are the second most UV-affected organ. According to, overexposure to UV rays can lead to vision loss, cataracts, corneal sunburns and even skin cancer of the eyelids. To protect your vision, wear a wide-brimmed hat that keeps your face and eyes shaded from the sun at most angles. Sunglasses should also be worn to protect your eyes. Choose a pair that reduces glare, filters UV rays and wraparound to protect your eyes from most directions. According to, it is important to read sunglasses labels to make sure it clearly states it blocks 99 to 100 percent of UVA and UVB rays.

Use the UV Index Scale

When planning your outdoor activities, you can decide how much sun protection you need by checking the UV Index Level. This index measures the daily intensity of UV rays from the sun on a scale of 1 to 11. A low UV index requires minimal protection, whereas a high UV index requires maximum protection.

Be Proactive

Regardless of whether the sun is shining or clouds are hovering, be proactive and apply sunscreen daily. While sunscreen is a great tool, ultimately the best prevention for skin cancer will always be getting your annual skin screening. Early detection saves lives and the skin health experts at Forefront Dermatology are ready to help. To schedule your annual screening find the Forefront dermatologist nearest you, visit the locations page today.


Lyme Disease and Your Skin

Tick season is in full swing this summer, increasing your risk of developing Lyme disease. Lyme disease is spread by the bite of the Ixodes tick, usually no bigger than a pinhead. Because a tick is so tiny and its bite is generally painless, the tick is often hard to detect. Unfortunately, if not promptly diagnosed and treated, Lyme disease can cause serious problems involving the eyes, heart, joints and nervous system.

The number of cases of Lyme disease has been on the rise since 1990. The US saw an increase from around 8,000 cases in 1990 to over 39,000 in 2009. The states with the highest number of cases are Connecticut, Rhode Island, New York, New Jersey, Delaware, Pennsylvania and Wisconsin.

Your Skin is the First Indicator

Lyme disease is caused when a tick passes on the spirochete bacteria known as Borrelia through its bite. According to the Center for Disease Control and Prevent, 70 to 80 percent of infected people develop a round red rash, called erythema migrans, in one or multiple areas on the body within 3 to 30 days of the tick detaching from the skin.  The rash may be solid red, clear centrally as it expands, forming a ring, or may have multiple concentric rings called a “bulls-eye” appearance. The rash is commonly about four inches across when seen, but may cover large areas of the body. The rash can last for a few days or for more than a month and may be painless or can feel painful, itchy or hot to the touch.

LYME-DISEASE-DIAGRAMOther early symptoms of Lyme disease include flu-like symptoms, low-grade fever, fatigue, headaches and muscle or joint aches and pains. Later stages of the disease don’t develop until weeks or many months later. Many complications can follow an untreated case of Lyme disease. These include meningitis (stiff neck, headaches, vomiting, fever), Bell’s palsy (paralysis of part of the face), heart block and irregular heartbeats, painful joints, muscles and bones.  Lyme disease is diagnosed based on symptoms, physical exam with your dermatologist and probability of exposure to infected ticks.  Laboratory testing can be helpful, but only if used and interpreted correctly and performed with validated methods.  Early treatment typically consists of orally administered antibiotics.

Be Proactive

If you are experiencing a suspicious rash and aren’t sure what the underlying cause is, the skin health experts at Forefront Dermatology are ready to help.  To find the Forefront dermatologist nearest you, visit our locations page today.