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Five Questions for dermatologist Jacqueline Dolev

She’s got medical degrees from Yale and Stanford. She’s on the board of directors of the California Society of Dermatology and Dermatologic Surgery. She’s a clinical professor at the University of California, San Francisco. But most important, she’s a good sport when it comes to inspecting the scars of party guests she’s just met.

Meet renowned San Francisco dermatologist Jacqueline Dolev, owner of Dolev Dermatology in the prestigious Pacific Heights neighborhood of San Francisco. One might expect a woman with such an impressive dossier and upscale address to be a tad uppity. But Dr. Dolev is as charismatic and down-to-earth as they come, with a complexion as bright as her intellect (no surprise there). She’s also as funny as hell. Here, she addresses our concerns about everything from snake oil to self skin checks, and even lets us in on a little secret about what not to do after hopping onto the examination table.

RT: What’s the craziest thing about your profession?

JD: Sometimes I’ll be at a party and someone who finds out I’m a dermatologist will say, “Can you take a look at this?” and drop their pants or pull up their shirt in the middle of the room. Needless to say, a party is not the ideal setting for a check-up, so the quality of care goes down dramatically [laughs]. It’s funny, but it happens. And I’m happy to take a quick look if it’s an easy problem, but it’s sort of like if you meet an attorney at a party, and then pull a settlement out of your purse and ask her to read it.

RT: What do you want more women to know about skincare?

JD: First, they should know there’s a lot of snake oil out there. I think a lot of women are tempted—and I’m the same way—to think that if a product is more expensive it’s somehow better. But that’s not necessarily true. Instead of seeking out the most luxurious brands, you want to find quality ingredients, and the fact is you can find them in some drug store brands. My advice is not to be influenced by the packaging. Turn the bottle around and look for the zinc sunscreen, look for those hydrating ceramides. Another thing I hear all the time from patients is, “I drink a lot of water, so I shouldn’t be dry.” This is the number one misconception about skincare. Internal consumption of water doesn’t affect the skin too much—the hydration needs to go from the outside in, so a good moisturizer is [imperative]. And finally, I wish more women understood that sunscreen is their biggest anti-aging weapon, and that titanium oxide and zinc oxide work better than chemical sunscreen. People think we don’t get a lot of sun exposure here in San Francisco, but UVA rays can penetrate glass. I can tell if a patient does a lot of driving, because she’ll have more sun damage on the left side of her face.

RT: You’re naturally beautiful—but do you ever feel pressure to look good on the job?

JD: I definitely want to look like myself, but at the same time represent what healthy youthful skin looks like. For both my patients and myself, I strive for a balance between looking youthful and looking natural. I have patients who ask me to remove every bump on their skin, but that’s not what we’re supposed to look like. It looks natural to have some freckles or a few moles, and it looks better to have a mole than a scar where the mole was removed. I also strive for natural results when dealing with injectables like fillers. The biggest compliment I get from patients after a procedure is when they tell me that their friend wanted to know if they’d been on vacation, or that their husband noticed how rested they look. That’s why we call it rejuvenation.

RT: So what should we be doing religiously?

JD: You should, first and foremost, incorporate a daily sunscreen into your regimen. And absolutely do a self-exam every year—the guideline is to check your birthday suit on your birthday. Another thing is to avoid harsh abrasives like wash towels or scrubs. For gentle exfoliation and brightness, I prefer glycolic acid or low-dose Retin-A. Now that it’s warmer outside, I’m getting my patients ready for summer with IPL (intense pulsed light) treatments, a type of photofacial that evens out your complexion, corrects brown spots and pulls the weeds, so to speak. This is something you should do before the summer, because you’re sun-sensitive for about a week afterward and you can’t do the procedure while you’re tan.

RT: What’s the funniest thing that’s ever happened during an exam?

JD: [Laughs] This is actually something that happens a lot. As soon as I start to do a skin check, a woman immediately tells me, “I’m sorry, Dr. Dolev, but I didn’t shave my legs today.” Which, of course, is ridiculous, because I don’t care whether or not she’s shaved. It’s interesting because my male patients never say anything like that. So my advice to the ladies would be: Don’t be self-conscious. Be confident.

UCSF Medical Students Undergo Art Training

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By Carolyn Johnson

SAN FRANCISCO — Medical students at UCSF are receiving some specialized training that could help them make clearer, more accurate diagnoses. But this training isn’t happening in a lab or a hospital — it’s in an art gallery.

Wandering the halls of the de Young Museum patrons are reminded that art can imitate life or even obscure it. But, can it really teach anything about saving lives?

Some first-year medical students there are part of the program that uses art to help them analyze and more accurately describe what they see.

“From a distance I thought she was holding a baby. But, this might be a bias of mine because I just came from a nursery,” answered UCSF medical student Alison Ong.

Ong, who first noticed what may be a woman and child on the shadowy steps of a painting, is studying to be a pediatrician.

“It wasn’t the woman I noticed first, but the baby she was carrying. I thought maybe there’s some bias there because she was holding a baby in the lap,” she said.

Visual trainer Tish Campbell leads the tours and encourages students to challenge their own interpretations by looking further.

“There have been misdiagnoses, especially with radiologists, where they’re not looking deeply enough and the answers are incorrect. So, visual strategies help students work that muscle,” she explained.

The program was developed at Yale University. Studies there showed that students who underwent the art training consistently scored higher when making diagnoses based on visual evidence. Dr. Jacqueline Dolev helped bring the program to UCSF.

“Physicians are like detectives. We gather evidence everywhere we can, and so much of that is visual,” she told ABC7.

To some students there is also value in the universal emotions depicted in art, perhaps leading to better understanding the visual cues expressed on a patient’s face.

“Because you clue into cues, maybe verbally, kids can’t tell you about it. You can cue into emotions if they’re grasping you or not,” said Ong.

The Visual Observation Training is an elective at UCSF, but it is now a required course at several other medical schools across the country.

Cracked Corners of the Mouth

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Understanding angular cheilitis or perleche

A Consultation with Dr. Jacqueline C. Dolev

 

Dear Doctor,
I have noticed cracking at the corners of my mouth, which lately won’t seem to go away. What is it and what should I do?

Dear Joan,
Cracked corners of the mouthCracking of the corners of the mouth is a common condition that is frequently seen in both the offices of dermatologists and dentists. It is known as perleche or angular cheilitis (“angular” – angles; “cheil” – lip; “itis” – inflammation). Perleche is derived from the French word, “lecher,” meaning to lick, and is characterized by excessive licking of the affected areas — either as a result of irritation or because of it. This condition is further characterized by redness and cracking of the skin at the corners of the lips.

There can be a variety of causes with the majority of them being “local,” meaning they arise from inside or around the mouth. Although uncommon, systemic (bodily) diseases may predispose to perleche as well. Once the corners of the mouth are fissured or cracked, saliva accumulation and contamination can lead to infection. The most common infection is from yeast called, “candida albicans.”

Outside The Mouth Going In

Perleche is found most often in children and younger adults who drool during their sleep and/or have orthodontic braces. In older adults, part of the aging process causes skin wrinkling with superficial or deep lines extending from the mouth and down the chin called, “marionette lines.” Wrinkling is the result of skin thinning from sun damage and constant exposure to the environment over the years, and with fat and connective tissue loss, the lips thin as well. Perleche may be more evident in the winter with colder weather and drier air. Cracking of the corners of the mouth, and subsequent licking to keep them moist, sets the stage for infection.

Inside The Mouth Going Out

Conditions inside the mouth leading to perleche include anything that affects normal and healthy saliva flow or causes mouth dryness that in turn leads to infection.

Other causes include:

  • Denture stomatitis (“stoma” – mouth; “itis” – inflammation) is an inflammation of the tissues under a denture. If dentures are not removed and cleaned regularly, dryness and subsequent chronic yeast infections can develop.
  • A lack of teeth, especially the back teeth that support the face, cheeks and lips, can lead to bite collapse with subsequent cracking or fissuring at the corners of the mouth, also giving rise to a prematurely aged look.
  • Systemic (general body) conditions like iron-deficiency anemia, B vitamin deficiency, diabetes and cancer can also lead to changes in the health and integrity of the oral mucous (mouth) membranes.

These conditions can predispose people to yeast infections, and perleche at the angles of the mouth.

Fixing The Cracks At The Corners

Chronic yeast infections may cause only minor discomfort while acute infections can affect the whole mouth and throat. In either case, they can be treated with a course of oral or topical antifungal (yeast) medication. Nystatin may be used as a troche (a small medicated lozenge designed to dissolve) that is rinsed with and then swallowed so that it works in the mouth and throughout the body. Antifungal ointments can also be applied liberally to the corners of the mouth several times a day to clear infection. They may be used in combination with a steroid ointment to control redness and inflammation, as well as zinc oxide paste or ointment, which is a barrier (skin) repair agent that has antifungal properties.

If infection arises from inside the mouth, it is likely to recur if only the corners of the mouth are treated. Chlorhexidine rinses can also be used to treat minor oral yeast infections. It is also effective for cleaning and scrubbing dentures; however, it is important to leave them out at night.

Optimal oral health and proper lip support from within the mouth can lessen or remove the cracking and wrinkles at the lip corners.

Although not as common, any systemic conditions that cause perleche will also need to be treated. Your dentist should also replace any missing teeth and ensure that dentures are properly fitting. Optimal oral health and proper lip support from within the mouth can lessen or remove the cracking and wrinkles at the lip corners. He/she should verify that oral hygiene is good, gum tissues are healthy and teeth decay free.

Modern dermatology can provide a variety of ways to treat lip wrinkles and marionette lines associated with perleche, and improve skin quality in general. This ranges from proper skin care to laser resurfacing. Facial fillers and fat may be used to replace the loss of connective tissue in the lips and provide support due to aging. Laser, fillers and other techniques can be used to remove both superficial and deep wrinkles and result in a healthier, rejuvenated appearance. This subject will be covered more fully in an upcoming issue of Dear Doctor magazine.

– See more at: http://www.deardoctor.com/inside-the-magazine/issue-15/cracked-corners-of-the-mouth/#sthash.cqvADK4K.dpuf