IN Better Health

with Jennifer Williams

DERMATOLOGY TODAY covers a myriad of treatments and encompasses everything from acne and skin cancers to aesthetic treatments which address the aging process.

When patient Jennifer Williams, a nurse practitioner herself, decided to make an appointment with dermatologist Dr. Zeena Al-Dujaili, she had a number of issues on her plate that she wanted to discuss with her physician.

“I initially came in for anti-aging treatments, but we began to discuss how to address my adult acne,” remembers Williams. “I didn’t have extremely visible facial acne that was as bad as many people endure, but most people didn’t know I had body acne which was not only embarrassing, but painful as well. With age, it was continuing to worsen.”

Upon examination, Dr. Zeena found an abundance of acne on Jennifer’s back, which can occur for a multitude of reasons, including stress and heat, and hormonal changes – even coming off birth control pills. Regardless of any underlying causes, both doctor and patient decided to engage in tackling the problem.

“There are different types of acne –comedonal (causing bumpy skin and oil-blocked hair follicles) and cystic (painful bacteria and pus-filled pimples),” explains Dr. Zeena. “The patient had a combination of these two types. We decided initially to treat it with a topical retinoid, but she really needed a stronger option, which was Accutane (isotretinoin) taken orally.”

Isotretinoin has long been the gold standard for treating recalcitrant acne, but treatment must be followed closely by a licensed medical doctor, who monitors for any side effects. The drug cannot be taken by anyone who is pregnant or trying to become pregnant. However, used properly, it can be extremely effective.

“The patient had previously been on antibiotics, to no avail,” notes Dr. Zeena. “After three or four months of Accutane, we noticed a remarkable difference, and at six months, the acne was gone. We now have her on topical tretinoin therapy, as maintenance.”

For Williams, it wasn’t until her acne was gone that she realized how much of her life had revolved around her skin problems.

“I recently went on my first beach vacation (with plenty of hats and SPF) since completing treatment,” recounts Williams. “I used to always have to worry when the breakouts would occur, plan for back-up outfits, have different make-up to try to cover it up, and basically plan my whole vacation around this problem.

On this recent vacation, I texted Dr. Zeena and her staff a photo of myself on the beach, and thanked them for the confidence that I was able to pack with me.”

Jennifer has now begun treatments to resurface the damaged skin that was the result of years and years of chronic acne.

Skin damage, however, can occur over time from a factor much more common than acne... the sun. The damage that occurs from sun exposure is one of the major reasons that people age prematurely, acquiring excess lines, wrinkles and loss of skin elasticity. Skin

Dr. Zeena Al-Dujaili.

damage is cumulative, so often how you treat your skin today will have repercussions years, even decades, down the road. Excess tanning can have much more drastic consequences than wrinkles, however, in the form of various types of skin cancers. Trained as a Mohs surgeon (a subspecialty of dermatology which requires advanced schooling), Dr. Zeena removed skin cancers on her New York City patients, before opening her own practice in New Orleans. That procedure entails surgically removing tissue layer by layer until no cancer cells remain.

“Most patients don’t realize that you don’t have to be lying on the beach or even be outside for extended periods of time to damage your skin cells,” comments Dr. Zeena. “There’s a great picture that was shown in the Wall Street Journal of a truck driver who drove for years with his driver side window down, and his arm hanging out. The left side of his body, which was getting the sun, looked weathered...nothing like his right side. Wearing sunblock with an SPF of 30 or higher which contains zinc or titanium actually acts as a physical shield when applied often enough. I tell patients to get up in the morning, wash their face, apply an antioxidant like vitamin C and then apply sunscreen, whether they’re going in the sun, or not. Damaging rays come through windows and even penetrate clouds on an overcast day.”

For those who do wish to reverse the effects of aging and sun damage, Dr. Zeena is fellowship-trained in cosmetic dermatology and assesses each patient individually, engaging them in conversation about what specifically on their face they would like to improve. There are injectables like Botox and Dysport which work to weaken or paralyze certain active muscle groups, or fillers like Juvederm and Restylane which plump up areas in the face which have lost springiness and tightness from the loss of collagen. There is also microneedling which causes small injuries to the skin which helps create collagen as the body heals. There are a wide array of treatments which Dr. Zeena is eminently qualified to employ.

“There’s still no replacement for taking care of your skin from a young age, recounts Dr. Zeena. “That means protecting it from the sun and free radicals and nourishing it from the inside out by maintaining a healthy diet.”

When it comes to your skin, the old adage certainly applies; an ounce of prevention is decidedly worth a pound of cure.