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On behalf of my staff and family I would like to wish all of you a very Happy Holidays and healthy New Year.   We would like to sincerely thank you for allowing us to provide care to you, your family and friends.   Over this last year we have participated in the joys of our patients’ marriages, anniversaries, graduations, job opportunities, and births.  We have also had some close encounters with over a dozen melanomas being detected and successfully treated this year.  Sharing in the health, celebrations, and challenges of my patients has been personally meaningful and fulfilling.

With 2012 around the corner please remember to wear your sunscreen, check your skin for any new or changing “spots,” and call us when we may of service for your dermatologic and cosmetic needs. We are truly grateful that you are our patient.  Happy Holidays!

Best Wishes,
Darrell W. Gonzales, M.D.

Check out the following link to the San Diego Union Tribune for Dr. Gonzales’ opinion about tanning beds: Tanning Industry Feels the Heat.

“There’s no absence of data showing that tanning salons increase the risk of skin cancer,” said Dr. Darrell Gonzales, a dermatologist with Scripps Health. “I never like to see a small business go out of business, but if it’s promoting something that causes cancer, I don’t see any alternative.”

All joking aside, rosacea is a common problem that can affect any skin type. There are several different variants including vascular rosacea, papulopustular rosacea, and ocular rosacea.  What makes rosacea so frustrating is that there is no one single cause of it and therefore no one simple cure to fix it.  The one universal finding that we understand about rosacea is that it is related to skin vascular hyper-reactivity and inflammation. Although demodex mites have been found on the faces of people with rosacea, there is no scientific evidence that it plays any primary role in its causation.

There are both topical and oral treatment options to help control and halt the process of rosacea.  Both topical and oral antibiotics have been used to treat rosacea, but there is some very reasonable concern that the overuse of these medications may lead to bacterial resistance.  Ideally, it is best to treat rosacea with topical agents such as metronidazole and sodium sulfacetamide.  These products work for many rosacea patients without the risk of developing antibiotic resistance.  For patients with more persistent, pustular, or inflammatory rosacea, oral antibiotics are sometimes necessary and effective.  One of the most common forms of oral antibiotics for the treatment of rosacea is doxycycline.  Fortunately, there are newer formulations of doxycycline with concentrations that can treat rosacea without running the risk of antibacterial resistance.  Persons with rosacea not responding to topical agents should ask their dermatologist about this special formulation of doxycycline.

There is no doubt that rosacea is a frustrating skin problem and patients will often be willing to try extreme measures to treat rosacea, including Accutane.  Accutane is an oral medication FDA approved for the treatment of nodulocystic acne.  At low doses it has been found to help improve rosacea for some individuals.  Unfortunately, this medication has a long list of potential side effects even at low levels.  Besides being potentially toxic to the liver, it can cause an elevation in triglycerides, increased sensitivity to sunlight, and birth defects should a woman get pregnant while on the medication.  There is some concern that Accutane may also be associated with possible mood changes or inflammatory bowel disease.  The medication requires monthly bloodwork and a physician office visit to verify that the individual is tolerating the medication well.  Although I may see some benefit with persons with severe forms of rosacea, I am not a major proponent of Accutane for my patients as I prefer less toxic and in most cases equally effective medications.

If you have further questions about rosacea, call and schedule an appointment today.  I will work with you to find the best treatment options based on your needs.

The FDA approved a new medication for the treatment of late-stage melanoma in March 2011.  Ipilimumab, which will be marketed as Yervoy, has shown in clinical trials to help improve the overall survival in patients with late-stage melanoma.

This medication acts by sustaining the immune system’s attack against malignant cells.  Although exciting news for individuals currently diagnosed with late-stage melanoma, the medication has no guarantee and may increase life expectancy by just a few months.  Additional clinical trials are planned to further investigate the drug.  Regardless, Ipilimumab is a great advancement in medical science that provides new hope for existing patients with this severe disease as well as persons who will be diagnosed in the future.

The most important thing to remember is that early detection saves lives.  If you observe something new or changing on your skin it is important to have it evaluated immediately.   Early detection and treatment are the best predictors of a very high survival rate.  Protection from the sun’s ultraviolet light is always the first step in avoiding skin cancer.  Please enjoy the outdoors, but remember to wear sun protective clothing and sunscreen with at least an SPF of 30.

As medical science has rapidly evolved one thing has remained relatively dormant is the way physicians have kept medical records.  In most medical offices, your information and progress notes have been documented with pen and paper.  Although this form of documentation has been sufficient, it has also limited the ability to share medical information between multiple physicians.  Over the last several years there has been a new push to advance they way physicians document your office visits, track illnesses, and manage medications.

All physicians will soon be obligated to transition to what is called electronic medical records (EMR).   This means your physician will no longer use pen and paper, but instead document your visit on a computer.  As technology evolves, these records will be available to other persons and institutions you grant access, including emergency room physicians, hospitals, and other medical specialists. Medications and allergies will also be documented and shared electronically.  The goal is for EMR to provide your physicians with more immediate and timely information regarding your medical health and reduce the bureaucracy currently inherent in the healthcare industry.

There are legitimate concerns with this type of system including the cost to implement this technology and secure your medical information.  Physicians will be responsible for paying for implementing EMR systems.  Government and computer science industry are also needed to develop safeguards so your information is protected from unauthorized persons gaining access.  Regardless of these obstacles and costs, EMRs are a certainty in the very near future.

The goal of Coastal Medical and Cosmetic Dermatology is to provide patients with the most up to date medical science and technology while providing personalized and compassionate care.  In order to provide this quality of care, Dr. Darrell Gonzales has supported the implementation of EMR in his office.  Your information is collected and maintained using some of the most sophisticated medical data software to document your office visits, laboratory data, and health information.  Your records are safely stored on an independent server so only those with permission can access your medical records.  Ultimately, this system assists Coastal Medical and Cosmetic Dermatology in providing you the best and most up to date standards in heath care.

It’s hard to believe that after our dreary summer even colder weather is to follow.  With the decrease in temperature also comes a drop in the humidity.   This can lead to very dry, itchy skin.  To help combat this dryness, Dr. Gonzales has recommended a few over the counter moisturizers that generate a protective barrier between your skin and the environment.  Your skin will thank you for it!

Cerave Moisturizer: This moisturizer contains a new technology that helps create a natural lipid barrier on your skin.  After one week of using the lotion your own skin will begin to manufacture its own moisturizing lipids.   Coastal Medical and Cosmetic Dermatology also carries Cerave Moisturizer for purchase.

Aveeno: This moisturizer has been around for a long time and for good reason.  It is relatively inexpensive and with consistent use will help to heal your dry skin.

Aquaphor: Although slightly heavier on your skin, this petrolatum based product really does the trick in helping to fight off the low humidity of the fall and winter.

Call Coastal Medical and Cosmetic Dermatology today if you have concerns about dry and irritated skin.

As our skin ages, one of the first things many of us discover is a loss of lip volume and a turning down at the corners of our lips causing a frown-like appearance.  This volume loss is predominantly caused by a gradual decline in collagen and elastin in our skin that ordinarily gives us a more full and tighter appearance. There are lots of over the counter products and department store cosmetic agents that promise a correction of this volume loss, but the great majority of these agents do not deliver.

One of the best fixes for this loss of lip volume and angled depression at the corner of the lips is to have a filler, such as Restylane, placed.  There are several fillers available in my office that do a wonderful job at restoring the natural volume of your lips, soften vertical lip lines and help to erase the frowns at the lip corners.  Two of my favorites include Restylane and Juvederm.  These fillers contain hyaluronic acid which is found normally in your skin.  Restylane and Juvederm can return a fullness to the lips that can not be duplicated with anything that is sold over the counter today.

The biggest concern my patients have when they first have this procedure done is will the volume be too much.   I never like over correction when fillers are placed as this can make the lips look too large and exaggerated.  My goal is to return the volume to your lips that you had when you were younger without anyone being able to detect what was done.  This is a truly great non-invasive procedure that my patient’s love.  It tends to restore confidence in one’s appearance and return your skin to a more youthful presentation.  Contact Coastal Medical and Cosmetic Dermatology  to discuss whether this procedure will work well for you at your next office visit.