Key messages

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With the generous financial support of its industry partners, the American Academy of Dermatology has developed these key messages to help you educate the public about the specialty. In addition to providing tips for media interviews, this quick reference tool provides clear, consistent talking points on the skin, hair, and nail topics most commonly requested by the media.

The media are valuable allies in educating the public about dermatologic conditions and raising awareness of the range of valuable services that dermatologists offer. By communicating these key messages, you can help position the specialty while increasing your credibility and raising the profile of your practice.

Select a topic

TIPS FOR MEDIA INTERVIEWS

Prior to an interview


Do your homework

  • Watch the show or read the reporter’s past articles.
  • Know the audience and determine what they want to know.
  • Do an Internet search on your topic. The reporter will do this too, so be aware of what’s new or controversial about the subject.

Identify what’s most important

  • Develop three key messages that you want the audience to remember.
  • Be prepared to explain why the audience should care.

Rehearse

  • Anticipate difficult questions. Be prepared to answer them.
  • Reporters are trained to ask the “who, what, when, where, why and how” of your subject area; make sure you can provide the appropriate responses.

During the interview


Get your messages across

  • State your key messages more than once during the interview to help the audience remember them.
  • Introduce them with strong language, such as “This is very important …” or “Let me emphasize that …”
  • When possible, use personal examples to which the audience can relate.
  • Use facts and statistics that establish your credibility.

Tell the truth

  • Don’t mislead. Never lie.
  • If you don’t know the answer, say so.

Don’t repeat negatives

  • If the reporter asks a tough question, rephrase it and transition back to your key messages.
  • If you get flustered, remember KISS: Keep It Short and Simple.

Be yourself

  • Answer as simply as possible without using medical jargon. If your audience does not understand what you are saying, they will stop listening or reading.
  • Smile.

Remember, there is no such thing as “off the record”

  • Do not say anything you do not want to see in print or hear on the air.

Make sure your last words are good ones

  • Give the audience a call to action and provide a resource like a website or phone number.

Overall key messages


  • Board-certified dermatologists are the physician experts in the diagnosis of skin, hair and nail conditions, and are specially trained to provide the highest-quality medical, surgical and cosmetic treatments.
  • The American Academy of Dermatology is a resource on thousands of skin conditions.
  • Visit aad.org to:
    • Learn more about conditions and treatment options, and get tips for keeping your skin, hair and nails healthy.
    • Find a board-certified dermatologist.
    • Get more information about beneficial programs and services that can enhance your skin health, such as free SPOTme® skin cancer screenings.

ACNE

  • Acne is the most common skin condition in the United States, affecting up to 50 million Americans annually.1
  • Acne often causes significant physical and psychological problems such as permanent scarring, poor self-image, depression and anxiety.2
  • See a board-certified dermatologist for the successful diagnosis and treatment of acne. Early treatment is the best way to prevent scars.

Acne facts

  • Acne, a chronic inflammatory skin condition, is characterized by blackheads, whiteheads, pimples and deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and upper arms.
  • Acne usually begins in puberty and affects many adolescents and young adults.
    • Approximately 85 percent of people between the ages of 12 and 24 experience at least minor acne.3
  • Acne can occur at any stage of life and may continue into one’s 30s and 40s.4-6
    • Acne occurring in adults is increasing, affecting up to 15 percent of women.4-6
  • In 2013, the costs associated with the treatment and lost productivity among those who sought medical care for acne exceeded $1.2 billion.7
    • More than 5.1 million people sought medical treatment for acne in 2013, primarily children and young adults.7
    • The lost productivity among patients and caregivers due to acne was nearly $400 million.7

Causes of acne

  • Acne is caused by many factors.
  • Overactive oil glands can produce too much oil and combine with skin cells to plug pores. When the pores in the skin become plugged, bacteria on the skin multiply, causing skin lesions.8-9
  • The following can bring on acne or make it worse:
    • Heredity/genetics
    • Hormones
    • Menstruation
    • Emotional stress
    • Medications
  • Foods with a high glycemic load such as white grains (bread, rice, pasta) and sweets may be associated with acne.2,10
    • For overall good health, people should eat a healthy, balanced diet.

Acne care

  • Gently wash affected areas twice a day and after sweating with mild, nondrying cleanser. Vigorous washing and scrubbing can irritate your skin and make acne worse.
  • Shampoo hair often — daily if it is oily.
  • Use noncomedogenic, nonacnegenic and oil-free cosmetics, toiletries and sunscreens.
  • Avoid astringents, toners and exfoliants, which may unnecessarily dry the skin.
  • To prevent scars, do not pop, squeeze or pick at acne.
  • To reduce the risk of scarring, seek treatment early for severe acne that does not respond to over-the-counter medications.

Acne treatment

  • There are many effective acne treatments available. Your dermatologist can determine which treatments are best for you.2
  • Use the medications and products prescribed for your acne as directed, and allow enough time for them to take effect, which could be four to eight weeks.
  • Resolution of acne takes time. There are no overnight or immediate cures.
  • When your skin clears, treatment should continue in order to prevent new breakouts. Your dermatologist can tell you when to stop treatment.
  • Topical treatments are the standard of care for mild acne, and different topical medications, such as topical retinoids and benzoyl peroxide, may be combined to create an effective treatment regimen.2
  • Antibiotics (oral or topical) in combination with other treatments (such as topical retinoids and benzoyl peroxide) are the standard of care in the management of moderate and severe acne.2
    • Oral antibiotics can also be used for acne that is resistant to topical therapy or covers a large body surface area.2
    • Due to increasing bacterial resistance, it is best not to treat less severe forms of acne with oral antibiotics. If possible, the duration of antibiotic therapy should be limited to no more than three months.2
  • Some women find that oral contraceptives containing estrogen may help clear their acne if other treatments do not work. Other medications, such as spironolactone, that modify the skin’s response to male hormones also may be helpful.
  • Oral isotretinoin is the only medication approved for severe cystic acne, the most serious form of this skin disease.
  • Isotretinoin has been used as a course of treatment for acne for more than 25 years.2, 11-12
  • Treatment with isotretinoin often results in prolonged clearance of acne, which can be permanent for some patients.13-14
  • Mood disorders, depression, suicidal ideation and suicides have been reported in patients taking oral isotretinoin, but a causal relationship has not been established.2, 15-18 Many studies have indicated that treatment of acne with isotretinoin was accompanied by improvement of both depressive and anxiety symptoms, as well as improved quality of life.19-21
  • Isotretinion cannot be prescribed to a pregnant female patient, and women who can become pregnant must follow strict rules to prevent pregnancy. The risk of a baby developing severe birth defects is high, even in patients taking the medicine for a short time.2, 22
  • The AAD is committed to the safe and responsible use of isotretinoin and supports continuing education for physicians and patients to prevent fetal exposure and other potential hazards connected to the use of this medication.2
  • For the Academy’s position statement on isotretinoin, visit the Academy website.
  • Prescribers, patients, pharmacies, drug wholesalers and manufacturers of isotretinoin in the U.S. are required to register with the iPLEDGE program. This program requires mandatory registration of all patients receiving this drug. Detailed information can be found on the iPLEDGE website at ipledgeprogram.com.
  • Current evidence is insufficient to prove either an association or a causal relationship between isotretinoin use and inflammatory bowel disease in the general population.20, 23-24 While some recent studies have suggested such a relationship,19, 25-26 further studies are required to conclusively determine if the association or causal relationship exists and/or whether IBD risk may be linked to the presence of severe acne itself.
  • Laser and light-based therapies continue to be researched for their effects on mild to moderate acne.27-28
  • Laser resurfacing, dermabrasion, chemical peels and skin fillers provide safe and effective treatments for acne scarring. Since acne scars are unique in their appearance and often have complex characteristics, patients should consult their dermatologist to determine an individualized treatment plan for the best result.

More information

Acne
Acne scars
Isotretinoin


1. Bickers DR, Lim HW, Margolis D, Weinstock MA, Goodman C, Faulkner E et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. Journal of the American Academy of Dermatology 2006;55:490-500.

2. Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology 2016;74:945-73.e33.3.

3. Bhate K, Williams HC. Epidemiology of acne vulgaris. The British journal of dermatology 2013;168:474-85.

4. Holzmann R , Shakery K. Postadolescent acne in females. Skin pharmacology and physiology 2014;27 Suppl 1:3-8.

5. Khunger N , Kumar C. A clinico-epidemiological study of adult acne: is it different from adolescent acne? Indian journal of dermatology, venereology and leprology 2012;78:335-41.

6. Tanghetti EA, Kawata AK, Daniels SR, Yeomans K, Burk CT , Callender VD. Understanding the Burden of Adult Female Acne. The Journal of Clinical and Aesthetic Dermatology 2014;7:22-30.

7. American Academy of Dermatology/Milliman. Burden of Skin Disease. 2017. www.aad.org/BSD.

8. Katsambas A, Papakonstantinou A. Acne: systemic treatment. Clinics in dermatology 2004;22:412-8.

9. Bhate K, Williams HC. What’s new in acne? An analysis of systematic reviews published in 2011-2012. Clinical and experimental dermatology 2014;39:273-7; quiz 7-8.

10. Melnik BC. Linking diet to acne metabolomics, inflammation, and comedogenesis: an update. Clinical, Cosmetic and Investigational Dermatology 2015;8:371-88.

11. Peck GL, Olsen TG, Butkus D, Pandya M, Arnaud-Battandier J, Gross EG et al. Isotretinoin versus placebo in the treatment of cystic acne. A randomized double-blind study. Journal of the American Academy of Dermatology 1982;6:735-45.

12.  Rao, P. K., Bhat, R. M., Nandakishore, B., Dandakeri, S., Martis, J., & Kamath, G. H. (2014). Safety and efficacy of low-dose isotretinoin in the treatment of moderate to severe acne vulgaris. Indian journal of dermatology, 59(3), 316.

13. Layton A. The use of isotretinoin in acne. Dermatoendocrinology. 2009;1(3):162–169.

14. Leyden JJ, Del Rosso JQ, Baum EW. The use of isotretinoin in the treatment of acne vulgaris. J Clin Aesthet Dermatol. 2014;7(2 Suppl):S3-S21.

15. Kaymak Y, Taner E, Taner Y. Comparison of depression, anxiety and life quality in acne vulgaris patients who were treated with either isotretinoin or topical agents. International journal of dermatology 2009;48:41-6.

16. Hahm BJ, Min SU, Yoon MY, Shin YW, Kim JS, Jung JY et al. Changes of psychiatric parameters and their relationships by oral isotretinoin in acne patients. The Journal of dermatology 2009;36:255-61.

17. Magin P, Pond D, Smith W. Isotretinoin, depression and suicide: a review of the evidence. The British journal of general practice : the journal of the Royal College of General Practitioners 2005;55:134-8.

18. Oliveira, J. M., Sobreira, G., Velosa, J., Telles Correia, D., & Filipe, P. (2017). Association of isotretinoin with depression and suicide: a review of current literature. Journal of cutaneous medicine and surgery, 1203475417719052.

19. Wolverton SE, Harper JC. Important controversies associated with isotretinoin therapy for acne. American journal of clinical dermatology 2013;14:71-6.

20. Yesilova Y, Bez Y, Ari M, Kaya MC, Alpak G. Effects of isotretinoin on obsessive compulsive symptoms, depression, and anxiety in patients with acne vulgaris. The Journal of dermatological treatment 2012;23:268-71.

21. Marron SE, Tomas-Aragones L, Boira S. Anxiety, depression, quality of life and patient satisfaction in acne patients treated with oral isotretinoin. Acta dermato-venereologica 2013;93:701-6.

22. Food and Drug Administration. www.ipledgeprogram.com.

23. Bernstein CN, Nugent Z, Longobardi T, Blanchard JF. Isotretinoin is not associated with inflammatory bowel disease: a population-based case-control study. The American journal of gastroenterology 2009;104:2774-8.

24. Crockett SD, Gulati A, Sandler RS, Kappelman MD. A causal association between isotretinoin and inflammatory bowel disease has yet to be established. The American journal of gastroenterology 2009;104:2387-93.

25. Crockett SD, Porter CQ, Martin CF, Sandler RS, Kappelman MD. Isotretinoin use and the risk of inflammatory bowel disease: a case-control study. The American journal of gastroenterology 2010;105:1986-93.

26. Reddy D, Siegel CA, Sands BE, Kane S. Possible association between isotretinoin and inflammatory bowel disease. The American journal of gastroenterology 2006;101:1569-73.

27. Hamilton FL, Car J, Lyons C, Car M, Layton A, Majeed A. Laser and other light therapies for the treatment of acne vulgaris: systematic review. The British journal of dermatology 2009;160:1273-85.

28. Momen S, Firas AN. Acne vulgaris and light-based therapies. J Cosmet Laser Ther 2015;17:122-28

AGING SKIN

  • Exposure to ultraviolet radiation is the most preventable cause of early skin aging. UV radiation is emitted by the sun and indoor tanning beds.
  • The most effective ways to prevent wrinkles and sun damage are seeking shade, wearing protective clothing and regularly using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.
  • A board-certified dermatologist can perform a variety of in-office procedures to reduce the signs of aging. (See Cosmetic surgery.) Your dermatologist can help you determine which treatment option is best for you.

Wrinkles

  • How wrinkled your skin becomes depends on many factors, including your skin type, genetics, and history of unprotected sun exposure and indoor tanning.
  • People with fair skin who have a history of UV exposure are particularly susceptible to wrinkles, skin damage and skin cancer.
  • Studies show that exposure to UV radiation from indoor tanning beds damages the DNA in skin cells, leading to premature skin aging and skin cancer.1-2

Age spots

  • Age spots are flat, brown marks on the skin. Also known as lentigines, they usually appear on the face, chest, back, backs of the hands and tops of the feet.
  • Age spots are caused by exposure to UV radiation. If age spots run in your family, you should take extra caution to avoid excessive UV exposure.

Skin care products and ingredients

  • There are many over-the-counter products and cosmetic procedures available to treat the signs of aging skin. Talk to your dermatologist to determine which treatment is right for you.
  • Sunscreen and moisturizer should be used regularly to prevent and treat the signs of aging. Some anti-aging moisturizers contain ingredients that help minimize the appearance of fine lines and uneven pigmentation.
  • Tretinoin cream 0.02% is the only topical prescription medication approved by the U.S. Food and Drug Administration for the treatment of fine facial wrinkles.
  • Retinol is an ingredient in many over-the-counter anti-aging products. While both retinol and tretinoin are in the vitamin A family, retinol is weaker than prescription tretinoin.
  • Alpha hydroxy acids can exfoliate the skin surface, which reduces rough texture and may improve fine lines caused by poor skin turnover.
  • Skin-lightening products made outside the United States may contain mercury. Ask a board-certified dermatologist to help you select one of the many safe products that are available to help lighten dark spots and unwanted pigment on the skin.
  • For information about cosmetic and personal care products and their ingredients, visit cosmeticsinfo.org. This website from the Personal Care Products Council contains information about the safety, testing and regulation of cosmetics and personal products. [Please note: The Academy has not reviewed or evaluated the information provided on the PCPC website.]

Tips for using skin care products

  • Wear sunscreen every day when you are going to be outside. UV rays can accelerate signs of aging. Use a sunscreen or moisturizer that offers broad-spectrum protection with an SPF of 30 or higher. Reapply sunscreen every two hours when you’re outside.
  • Do not tan. Getting a tan from the sun or a tanning bed exposes you to harmful UV rays that can accelerate aging, causing wrinkles, age spots, a blotchy complexion and even skin cancer.
  • Moisturize. Moisturizing traps water in the skin, which can help reduce the appearance of some fine lines and make your complexion look brighter and younger.
  • Test products, even those labeled “hypoallergenic.” To test, dab a small amount of the product on your inner forearm twice a day for four or five days. If you do not have a reaction, it is likely safe for you to apply the product to your face.
  • Use products as directed. Active ingredients can do more harm than good when used too much. Applying more than directed can cause clogged pores, a blotchy complexion, irritation or other unwanted effects.
  • Stop using products that sting or burn, unless they were prescribed by a dermatologist. Some prescription products may cause stinging or burning, but this can be safe and effective for patients under a dermatologist’s care.
  • Limit the number of products you use. Using too many products on your skin, especially more than one anti-aging product, can cause irritation. This often makes signs of aging more noticeable.
  • Shop smart. More expensive products aren’t necessarily more effective. There are some effective, affordable products in the skin care aisles of your local stores.
  • Give the product time to work. While a moisturizer can immediately plump up fine lines, most products take at least six weeks to work, and some can take three months.

More information

What causes our skin to age?
How to create an anti-aging skin care plan
How to maximize results from anti-aging skin care products
How to select anti-aging skin care products
Wrinkle remedies


1. Whitmore SE, Morison, WL, Potten CS, Chadwick C. Tanning salon exposure and molecular alterations. J Am Acad Dermatol. 2001;44:775-80.

 

2. Lim HW, James WD, Rigel DS, Maloney ME, Spencer JM, Bhushan R. Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: time to ban the tan. J Am Acad Dermatol. 2011;64: 893-902.

COSMETIC SURGERY

  • The American Academy of Dermatology urges patients considering cosmetic surgery to choose a board-certified physician. Board-certified dermatologists have expertise in the medical, surgical and cosmetic treatment of skin, hair and nails.
  • While nonphysicians performing cosmetic procedures in spas, shopping malls and walk-in clinics may offer convenience, the limited equipment, training and supervision available to handle complications or medical emergencies can jeopardize patients’ health and appearance.
  • The American Academy of Dermatology recommends that patients do their homework and consider a doctor’s training and credentials before deciding if a particular physician is the right choice for them. To find a board-certified dermatologist, visit aad.org/findaderm.

Questions to ask when considering cosmetic surgery

As with any surgical procedure, there are risks associated with cosmetic surgery. However, patients can reduce those risks by asking the right questions:

  • What are the doctor’s credentials? Is he or she a board-certified dermatologist or another appropriately trained physician? Ask to see his or her credentials.
  • Who is going to perform the surgery? How many of these procedures has the physician performed? The procedure should be one that the doctor performs regularly.
  • What results can be expected? How long is the recuperation period? Ask to see before and after photos of the physician’s previous patients, but remember that results may vary from patient to patient.
  • What are the risks? What type of anesthesia will the physician use? Do the benefits of my cosmetic surgery outweigh the risks? Will the doctor be available if the patient experiences complications?
  • Where is the procedure being performed? The procedure should be performed in a medical center or doctor’s office, not a nonmedical spa, shopping mall or private party.
  • What is the cost?

Wrinkle fillers

  • Wrinkle fillers, commonly known as fillers, can help restore a plump, youthful appearance to the skin.
  • Fillers are commonly used to treat facial lines and wrinkles, hollow cheeks, sunken eyes, receding chins, thinning lips and deep wrinkles between the eyes.
  • Filler substances are placed just below the surface of the skin to increase the skin’s volume.
  • Selecting the proper filler is an important part of the process, and dermatologists have the knowledge and expertise to help you decide which is best for you.
  • Remember: Injecting a filler is a medical procedure. Fillers need to be injected by an experienced and well-trained physician, such as a dermatologist, in order to achieve the best results and reduce the risk of side effects. Getting a filler injected in a nonmedical setting can be extremely dangerous.

Botulinum toxin therapy

  • Botulinum toxin weakens the affected muscle to soften wrinkles. It also can effectively treat excessive sweating in the palms or underarms.
  • A board-certified dermatologist can provide botulinum toxin treatment during a single office visit. The improvements last about three to four months — sometimes longer.
  • Getting botulinum toxin therapy in a nonmedical setting or buying it online can be extremely dangerous. This product should require a medical license to purchase. To protect your health, you should never get botulinum toxin injections at a nonmedical spa, salon, party or someone’s home.

Laser skin resurfacing

  • Laser skin resurfacing is a procedure specifically designed to remove superficial and moderately deep wrinkles of the face.
  • Lasers work by producing an intense beam of bright light that travels to the affected area of the skin.
  • Laser resurfacing treatments generally fall into one of two categories: ablative lasers and nonablative lasers.
    • Ablative lasers, which tend to be more invasive and require more recovery time, vaporize the outer layers of the skin.
    • Nonablative lasers, which are less invasive and require less recovery time, heat up the targeted tissue without actually destroying it.
    • Both types of lasers have potential risks and side effects.
  • Advancements in laser skin resurfacing allow healing to occur much more rapidly and with minimal discomfort to the patient. In addition, improvements in laser technology have allowed dermatologists to treat people of color safely and effectively.
  • The safety and effectiveness of a laser treatment will depend on the person performing it. To get the best results and reduce the risk of complications, see a board-certified physician with the appropriate training and experience, such as a board-certified dermatologist.

Liposuction

  • Liposuction is a surgical procedure to remove localized pockets of excess fat that do not respond to diet or exercise.
  • Dermatology is one of the only medical specialties that include liposuction training in residency requirements.
  • The tumescent liposuction technique, which was developed by a dermatologist and uses local anesthesia instead of general anesthesia, is the standard of care for the procedure due to its safety and effectiveness in office setting.1-4 Ask your physician whether your liposuction will be performed using tumescent local anesthesia.
  • Some of the aggressive approaches that are not recommended when selecting a physician to perform any kind of liposuction procedure include:
    • Using general anesthesia or conscious sedation.
    • Extracting excessive amounts of fat.
    • Performing multiple procedures during the same surgery.

Varicose and spider veins

  • Varicose veins are abnormally swollen or enlarged blood vessels caused by a weakening in the vein’s wall, which often leads to pain and swelling in the leg.
  • Spider veins, most commonly found on the face and legs, are formed by the dilation of a small group of blood vessels located close to the surface of the skin.
  • For many people, varicose and spider veins are simply a cosmetic concern. But for others, these conditions may cause pain and discomfort, or even lead to more serious problems.
  • The exact causes of spider and varicose veins are unknown, although heredity, pregnancy and hormonal changes are believed to be contributing factors.
  • Treatments include:
    • Laser procedures
    • Endovascular laser surgery
    • Radiofrequency closure
    • Ambulatory phlebectomy
    • Sclerotherapy
    • Intense Pulsed Light
  • Be cautious when choosing a treatment: Advertisements claiming to offer “permanent” or “painless” procedures may be misleading. Ask your physician about any health risks and possible side effects.

More information

Before getting cosmetic treatment, ask questions
Who should provide your cosmetic treatment
Botulinum toxin therapy
Fillers
Legs veins: Why we get them and how dermatologists treat them
Liposuction: What can it do for me?


1. Hancox JG, Venkat AP, Hill A, Graham GF, Williford PM, Coldiron B et al. Why are there differences in the perceived safety of office-based surgery? Dermatologic surgery: official publication for American Society for Dermatologic Surgery [et al] 2004;30:1377-9.

2. Starling J, 3rd, Thosani MK, Coldiron BM. Determining the safety of officebased surgery: what 10 years of Florida data and 6 years of Alabama data reveal. Dermatologic surgery: official publication for American Society for Dermatologic Surgery [et al] 2012;38:171-7.

3. Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. The Journal of dermatologic surgery and oncology 1990;16:248-63.

4. Kouba DJ, LoPiccolo MC, Alam M, Bordeaux JS, Cohen B, Hanke CW et al. Guidelines for the use of local anesthesia in office-based dermatologic surgery. Journal of the American Academy of Dermatology 2016;74:1201-19.

ECZEMA

  • Eczema is a generic term for a group of medical conditions that cause the skin to become inflamed, irritated and/or itchy.
  • There are two major types of eczema: allergic contact dermatitis and atopic dermatitis. Atopic dermatitis is the most common type of eczema, and many people use these terms interchangeably.
  • Eczema can have many causes, including allergic reactions, friction, prolonged exposure to heat and moisture, or contact with irritants, such as harsh chemicals. A board-certified dermatologist can help determine what’s causing your eczema and recommend an appropriate treatment.

Allergic contact dermatitis

  • The itching and blistering of allergic contact dermatitis can occur after contact with an allergen, a substance that causes an allergic reaction. These reactions typically appear within a few days of exposure.
  • Poison ivy, poison oak and poison sumac are the most common causes of allergic reactions in the United States. Each year, millions of Americans will be affected by contact with these poisonous plants.
  • Other common causes of allergic contact dermatitis include metals (such as nickel), rubber, dyes, cosmetics, preservatives and fragrances.
  • Contact dermatitis is by far the most common work-related skin disorder, accounting for 90-95 percent of all cases.1
  • Treatment to relieve symptoms includes identification and removal of potential allergens to prevent future reactions. Corticosteroids and topical immunomodulators (tacrolimus or pimecrolimus) may be prescribed to reduce symptoms. Additional treatment options are available for recurrent/persistent forms of allergic contact dermatitis.

Atopic dermatitis

  • Atopic dermatitis is frequently described as “the itch that rashes.” It is characterized by patches of dry, red skin that may have scales and/or crust. Often, there is intense itchiness, accompanied by the desire to scratch.
  • Eczema usually occurs on the face, neck, and the insides of the elbows, knees and ankles.
  • Atopic dermatitis affects nearly 28 million Americans of all ages.2
    • It affects up to 25 percent of children and 2 to 3 percent of adults.3
  • An estimated 60 percent of people with this condition develop it in their first year of life, and 90 percent develop it before age 5. However, atopic dermatitis can begin during puberty or later. 3-4
  • Genetic, immune and environmental factors may contribute to the development of atopic dermatitis.5
  • While there is no cure for atopic dermatitis, most cases can be controlled with proper treatment. The goals of treatment are to keep the skin moist, reduce inflammation and the risk of infection, and minimize the itch associated with the rash.
  • Effective treatment often requires a multifaceted approach that includes medication, proper skin care, trigger avoidance and coping mechanisms.
  • Treatment to relieve symptoms may include:
    • Moisturizers to help relieve dry skin.
    • Cold compresses applied directly to the skin to help relieve the itch.
    • Corticosteroids to help reduce inflammation.
    • Topical calcineurin inhibitors to help reduce inflammation.
    • Short-term, intermittent use of sedative antihistamines to help the patient get a good night’s sleep.
    • Phototherapy or immune-suppressing oral medications to help relieve moderate to severe cases that do not respond to other therapies.
  • In recent years, the U.S. Food and Drug Administration has approved a nonsteroidal topical ointment for treatment of mild to moderate atopic dermatitis and an injectable drug for the treatment of moderate to severe atopic dermatitis.6-7
  • In 2013, the costs associated with the treatment and lost productivity among those who sought medical care for atopic dermatitis was $442 million.8
    • The total medical cost of treating atopic dermatitis was $314 million, for an average of $101.42 per treated patient.8
    • The lost productivity among patients and caregivers due to atopic dermatitis was $128 million.8

More information

Atopic dermatitis
Atopic dermatitis video library
Contact dermatitis
Caring for a child with eczema


1. Cashman MW, Reutemann PA , Ehrlich A. Contact dermatitis in the United States: epidemiology, economic impact, and workplace prevention. Dermatologic clinics 2012;30:87-98, viii.

2. Adelaide HA. Review of Pimecrolimus Cream 1% for the Treatment of Mild to Moderate Atopic Dermatitis. Clinical Therapeutics. 2006; 28(12):1972-1982.

3. Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb;70(2):338-51.

4. Beltrani VS, Boguneiwicz M. Atopic dermatitis. Dermatol Online J 2003;9(2):1.

5. Nutten S. Atopic Dermatitis: Global Epidemiology and Risk Factors. Annals of Nutrition and Metabolism 2015;66(suppl 1):8-16.

6. U.S. Food & Drug Administration. www.fda.gov.

7. Eichenfield LFM, Friedlander SFM, Simpson ELMM , Irvine ADM. Assessing the New and Emerging Treatments for Atopic Dermatitis. Seminars in cutaneous medicine and surgery 2016;35:S92-6.

8. American Academy of Dermatology/Milliman. Burden of Skin Disease. 2017. www.aad.org/BSD.

HAIR LOSS

  • Many conditions and diseases can result in hair loss, as can improper hair care.
  • The most common cause of hair loss is hereditary thinning or baldness, also known as androgenetic alopecia.1 This condition affects an estimated 80 million Americans — 50 million men and 30 million women.2
  • While daily shedding is normal, people who notice their hair shedding in large amounts after combing or brushing and those whose hair becomes thinner or falls out should consult a board-certified dermatologist for proper diagnosis and treatment.

Causes of hair loss

  • Potential causes of hair loss, some of which are temporary, include:
    • Excessive or improper use of styling products such as perms, dyes, gels, relaxers or sprays, which can cause weathering or hair breakage.
    • Hairstyles that pull on the hair, like ponytails and braids.
    • Shampooing, combing or brushing hair too much or too hard.
    • Hair pulling, which may be a sign of a disorder called trichotillomania.
    • A variety of diseases, including thyroid disease and lupus.
    • Childbirth, major surgery, high fever or severe infection, stress, or even the flu.
    • Inadequate protein or iron in the diet, or eating disorders such as anorexia and bulimia.
    • Certain prescription drugs, including blood thinners, high-dose vitamin A, and medicines for arthritis, depression, gout, heart problems and high blood pressure.
    • Use of birth control pills (usually in women with an inherited tendency for hair thinning).
    • Hormonal imbalances, especially in women.
    • Ringworm of the scalp, a contagious fungal infection most common in children.
    • Some cancer treatments, such as radiation therapy and chemotherapy.
    • Alopecia areata, a type of hair loss that can affect all ages and causes hair to fall out in round patches.3

Psychosocial impact of hair loss

  • Hair loss can be dramatic and devastating for patients, negatively impacting their quality of life.4-5
  • Known psychosocial complications of hair loss include depression, low self-esteem, altered self-image, reduced self-confidence, and less frequent and enjoyable social engagement.4-5
  • The negative effects on quality of life may be worse in women due to societal pressure to be attractive.4-5
  • Treatment from a board-certified dermatologist may help improve quality of life.4-5

Treatment of hair loss

  • If you are experiencing hair loss, a board-certified dermatologist can evaluate your condition to determine the cause and recommend an appropriate treatment.
  • Topical minoxidil (for men and women, available over-the-counter) and oral finasteride (for men only, prescription only) have been shown to help the regrowth of hair or to slow hair loss. Hair loss caused by diseases such as thyroid disease may be reversed with treatment of the underlying disease.
  • Topical or injectable cortisone medications have been shown to accelerate the regrowth of hair in some types of hair loss.
  • Topical or oral estrogen or other female-specific hormones are sometimes prescribed for women experiencing hair loss.
  • Hair transplantation is a permanent form of hair replacement utilizing dermatologic surgery that involves moving some existing scalp hair to bald or thinning parts. It may benefit men with male pattern baldness, some women with thinning hair, and people who have lost some but not all hair from burns or other scarring injuries to the scalp, eyebrows or eyelashes.
  • Restoration surgery is another treatment option.
    • In scalp reduction surgery, bald scalp is removed and hair-bearing scalp is brought closer together to reduce balding.
    • In scalp expansion surgery, a physician temporarily inserts devices under the scalp to stretch hair-bearing areas, which also reduces balding.
    • In scalp flap surgery, a hair-bearing piece of scalp is surgically moved and placed where hair is needed.

More information

Hair loss
Alopecia areata
Do you have hair loss or hair shedding?
Could it be female pattern hair loss?
Hair loss in new moms
Hair styling without damage
How to stop hair damage
Hair transplants


1. Rossi A, Anzalone A, Fortuna MC, Caro G, Garelli V, Pranteda G et al. Multi-therapies in androgenetic alopecia: review and clinical experiences. Dermatologic therapy 2016;29:424-32.

2. Genetics Home Reference. U.S. National Library of Medicine. National Institutes of Health. https://ghr.nlm.nih.gov/condition/androgenetic-alopecia#statistics. Accessed March 30, 2018.

3. Dainichi T , Kabashima K. Alopecia areata: What's new in epidemiology, pathogenesis, diagnosis, and therapeutic options? Journal of dermatological science 2017;86:3-12.

4. Tucker P. Bald is beautiful?: the psychosocial impact of alopecia areata. J Health Psychol 2009;14:142-51.

5. Cartwright T, Endean N, Porter A. Illness perceptions, coping and quality of life in patients with alopecia. Br J Dermatol 2009;160:1034-39.

HUMANITARIAN EFFORTS

  • Many dermatologists offer their time, expertise and financial resources to help enrich the lives of people throughout the world. Their efforts make a difference in the lives of children and adults with skin, hair and nail disorders, many of which are life-threatening and impact patients’ quality of life.
  • Dermatologists’ commitment to public service ranges from offering free skin cancer screenings and funding shade structures across the country to offering summer camp for kids with chronic skin conditions and providing medical assistance in developing countries.
  • Visit aad.org for more information about the humanitarian efforts of the American Academy of Dermatology and its members.

Free SPOTme® Skin Cancer Screenings

  • The American Academy of Dermatology’s SPOTme® program aims to reduce the number of deaths from skin cancer in the United States by educating the public about skin cancer risk and providing free SPOTme® skin cancer screenings to detect skin cancer in its earliest, most treatable stages.
    • Since 1985, dermatologists have volunteered to provide more than 2.7 million free SPOTme® skin cancer screenings and detected more than 271,000 suspicious lesions, including more than 30,000 suspected melanomas.
  • In 2014, thanks to a grant from Bristol-Myers Squibb, the AAD began hosting SPOTme® screenings to targeted audiences who have the highest risk of melanoma.
  • The AAD’s Latino Outreach Program seeks to bring awareness, education and skin cancer screenings to underserved Latino populations.

Shade Structure Program

  • The American Academy of Dermatology provides grants of up to $8,000 each to install shade structures for nonprofit organizations and educational institutions that serve children and teens under the age of 18.
  • Each shade structure provides protection from dangerous ultraviolet rays, while an accompanying sign educates the public about how to protect themselves from the sun.
  • Since its inception, the program has awarded 368 shade structure grants to organizations across the country. Collectively, these shade structures provide shade to more than 800,000 individuals each day.

Camp Discovery

  • The American Academy of Dermatology’s Camp Discovery offers children and teens with chronic skin conditions a week of summer camp. Children have the unique opportunity to enhance their self-confidence, bond with other children who have similar dermatologic conditions, and enjoy a week’s worth of fishing, boating, swimming, horseback riding, arts and crafts, and more.
  • Dermatologists volunteer their expertise and time so campers can experience a typical week of camp under medical supervision.
  • More than 330 children and teens attend Camp Discovery free of charge each year, thanks to generous donations from individuals and companies.
  • Visit www.CampDiscovery.org for more information.

Medical assistance in developing areas

  • The American Academy of Dermatology offers dermatology residents travel grants that allow them to provide skin, hair and nail disease care to the Navajo Nation population in Arizona and HIV patients in Botswana.
  • The AAD also provides grants to individuals and organizations to fund international volunteer and humanitarian projects related to dermatology and global health care in underserved regions of the world.
  • The Academy works with Health Volunteers Overseas to match interested dermatologists with volunteer opportunities in other countries, where they train local health care providers in skin, hair and nail disease treatment, helping them develop the knowledge and skills to make a difference in their own communities.
  • For more information on these programs, visit aad.org.

More information

30 Years of Skin Cancer Awareness
SPOTme® Skin Cancer Screenings
Find a Free SPOTme®  Skin Cancer Screening
Shade Structure Program
Camp Discovery

Indoor tanning

  • Using indoor tanning beds before age 35 can increase your risk of melanoma, the deadliest form of skin cancer, by 59 percent; the risk increases with each use.1-4
  • Nearly 70 percent of tanning salon patrons are Caucasian girls and young women, and melanoma is the second most common cancer in females age 15-29.5-6
  • Avoid indoor tanning. If you want to look like you’ve been in the sun, consider using a self-tanning product, but continue to use sunscreen with it.

Who tans indoors?

  • Approximately 7.8 million adult women and 1.9 million adult men in the United States tan indoors.7
  • Research indicates that more than half of indoor tanners (52.5 percent) start tanning before age 21, while nearly one-third (32.7 percent) start tanning before age 18.8
  • About 10 percent of Caucasian female high school students have tanned indoors.9
  • The indoor tanning industry's revenue is estimated to be $5 billion a year.10

Risks of indoor tanning

  • The U.S. Department of Health & Human Services and the World Health Organization’s International Agency for Research on Cancer panel have declared ultraviolet radiation from the sun and artificial sources, such as tanning beds and sun lamps, to be a known carcinogen (cancer-causing substance).11
  • Indoor tanning equipment — which includes all artificial light sources (beds, lamps, bulbs, booths, etc.) — emits UVA and UVB radiation. The amount of radiation produced during indoor tanning is similar to that of the sun and in some cases may be stronger.12
  • Evidence from several studies has shown that exposure to UV radiation from indoor tanning devices is associated with an increased risk of melanoma and nonmelanoma skin cancer, such as squamous cell carcinoma and basal cell carcinoma.1-3, 13-17
  • Research indicates that UV light from the sun and tanning beds can both cause melanoma and increase the risk of a benign mole progressing to melanoma.18
  • Studies have demonstrated that exposure to UV radiation during indoor tanning damages the DNA in skin cells. Additionally, excessive exposure to UV radiation during indoor tanning can lead to premature skin aging, immune suppression and eye damage, including cataracts and ocular melanoma.13,19-22
  • In addition to the aforementioned risks, frequent, intentional exposure to UV light may lead to tanning addiction.23-24

Legislation/regulation

  • In May 2014, the U.S. Food and Drug Administration issued new regulations strengthening warnings for indoor tanning devices. These regulations include:
    • A strong recommendation against the use of tanning beds by minors under 18.
    • The reclassification of tanning beds and sunlamps from Class I to Class II medical devices, which means they are considered “moderate to high risk.” The FDA mandates additional oversight of Class II devices, requiring manufacturers to provide more safety assurances.
    • Labeling that:
      • Clearly informs users about the risks of using tanning beds.
      • Warns frequent users of sunlamps to be regularly screened for skin cancer.
      • Alerts users that tanning lamps are not recommended for people under 18 years old.
  • The American Academy of Dermatology Association supports state and national efforts that place restrictions on indoor tanning for minors, including restrictions on indoor tanning for minors 18 and under.
  • California, Delaware, the District of Columbia, Hawaii, Illinois, Kansas, Louisiana, Massachusetts, Minnesota, Nevada, New Hampshire, New York, North Carolina, Oklahoma, Rhode Island, Texas, Vermont and West Virginia have passed laws that prohibit minors under the age of 18 from indoor tanning.
    • Minors under the age of 18 are prohibited from using tanning devices in three counties in Maryland: Prince George’s County, Montgomery County, and Howard County.
  • Oregon and Washington have passed laws prohibiting minors under the age of 18 from using indoor tanning devices, unless a prescription is provided.
  • Connecticut, New Jersey and Pennsylvania have passed legislation banning minors under the age of 17 from using tanning devices.
  • Minors under the age of 16 are prohibited from using tanning devices in Indiana and Wisconsin, while minors under the age of 14 are prohibited from using tanning devices in Alabama, Georgia, Idaho, Maine, and North Dakota.

Academy position statement on indoor tanning

  • The AADA opposes indoor tanning and supports a ban on the production and sale of indoor tanning equipment for nonmedical purposes.
  • The AADA supports the WHO recommendation that minors should not use indoor tanning equipment because indoor tanning devices emit UVA and UVB radiation, and overexposure to UV radiation can lead to the development of skin cancer.
  • Unless and until the FDA bans the sale and use of indoor tanning equipment for nonmedical purposes, the Academy supports restrictions for indoor tanning facilities, including:
    • No person or facility should advertise the use of any UVA or UVB tanning device using wording such as “safe,” “safe tanning,” “no harmful rays,” “no adverse effects” or similar wording or concepts.

More information

Indoor tanning fact sheet
Dangers of indoor tanning
Position statement on indoor tanning
Indoor tanning youth access laws
Indoor tanning advocacy tools


1. The International Agency for Research on Cancer Working Group on artificial ultraviolet (UV) light and skin cancer. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancers: A systematic review. International Journal of Cancer: 2006 March 1;120:1116–1122.

2. Lazovich, D, et al. “Indoor Tanning and Risk of Melanoma: A Case-Control Study in a Highly Exposed Population.” Cancer Epidemiol Biomarkers Prev. 2010 June;19(6):1557-1568.

3. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012 Jul 24;345:e4757.

4. Corrections: Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. British Medical Journal 2012;345:e8503.

5. Choi, K., Lazovich, D., Southwell, B., Forster, J., Rolnick, S. J., and Jackson, J. Prevalence and characteristics of indoor tanning use among men and women in the United States. Archives of Dermatology, Vol. 146 2010, No. 12, pp. 1356-61.

6. Surveillance, Epidemiology, and End Results (SEER) program 18 registries. Data run July 25, 2018.

7. Guy GP, Berkowitz Z, Holman D and Hartman A. Recent Changes in the Prevalence and Factors Associated With Frequency of Indoor Tanning Among U.S. Adults. JAMA Dermatol 2015; Published online July 1, 2015

8. Watson M, Shoemaker M, Baker K. Indoor Tanning Initiation Among Tanners in the United States. JAMA Dermatol. Published online March 22, 2017. doi:10.1001/jamadermatol.2016.5898

9. Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance — United States, 2017. MMWR Surveill Summ 2018;67(No. SS-8):1–114.

10. Suntan, CA. 2016. Industry Statistics, Opening and Running a Tanning Salon. http://www.suntan.com

11. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Report on carcinogens, 14th ed: Ultraviolet-radiation-related exposures. 2016. http://ntp.niehs.nih.gov/go/roc14/

12. Hornung RL, Magee KH, Lee WJ, Hansen LA, Hsieh YC. Tanning facility use: are we exceeding the Food and Drug Administration limits? J AM Acad Dermatol. 2003 Oct;49(4):655-61.

13. Whitmore SE, Morison, WL, Potten CS, Chadwick C. Tanning salon exposure and molecular alterations. J Am Acad Dermatol 2001;44:775-80.

14. Lim HW, James WD, Rigel DS, Maloney ME, Spencer JM, Bhushan R. Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: time to ban the tan. J Am Acad Dermatol. 2011 May;64(5):893-902.

15. Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ. 2012 Oct 2;345:e5909

16. Karagas M, et al. Use of tanning devices and risk of basal cell and squamous cell skin cancers. Journal of the National Cancer Institute. 2002 February 6;94(3):224-6.

17. Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol 2014;70:847–57.

18. Shain, AH et al. The genetic evolution of melanoma from precursor lesions. N Engl J Med 2015; 373:1926-1936.

19. Piepkorn M. Melanoma genetics: an update with focus on the CDKN2A(p16)/ARF tumor suppressors. J Am Acad Dermatol. 2000 May;42(5 Pt 1):705-22; quiz 723-6.

20. Vajdic CM, Kricker A, Giblin M, McKenzie J, Aitken JF, Giles GG, Armstrong BK. Artificial ultraviolet radiation and ocular melanoma in Australia. Int J Cancer. 2004 Dec 10;112(5):896-900.

21. Walters BL, Kelly TM. Commercial tanning facilities:a new source of eye injury. Am J Emerg Med 1987;120:767-77.

22. Clingen PH, Berneburg M, Petit-Frere C, Woollons A, Lowe JE, Arlett CF, Green MH. Contrasting effects of an ultraviolet B and an ultraviolet A tanning lamp on interleukin-6, tumour necrosis factor-alpha and intercellular adhesion molecule-1 expression. Br J Dermatol. 2001 Jul;145(1):54-62.

23. Fisher DE , James WD. Indoor tanning--science, behavior, and policy. N Engl J Med 2010;363:901-3.

24. Lim HW, James WD, Rigel DS, Maloney ME, Spencer JM, Bhushan R. Adverse effects of ultraviolet radiation from the use of indoor tanning equipment: Time to ban the tan. J Am Acad Dermatol 2011;64:e51-60.

Nails

  • Our nails often reflect our general state of health. Changes in the nail, such as discoloration or thickening, can signal health problems, including liver and kidney disease, heart and lung conditions, anemia, and diabetes.
  • Symptoms that could signal nail problems include changes in color, shape and/or thickness, swelling of the skin around the nails, bleeding or discharge, and pain.
  • See a board-certified dermatologist for the successful diagnosis and treatment of nail problems.

Nail growth

  • Fingernails grow faster than toenails — especially on one’s dominant hand.
  • On average, fingernails grow 3.5 mm per month, while toenails grow about 1.6 mm per month.1
  • Nail growth rates depend on age, health status, time of year, activity level and heredity.
  • Women’s nails grow more slowly than men’s, except possibly during pregnancy.
  • Nails grow more rapidly in summer than in winter.
  • Nail growth is affected by disease, nutrition, medications, trauma, chronic illness, fever, and the aging process.

Nail problems

  • Nail problems make up about 10 percent of all dermatologic conditions.2
  • Nail problems usually increase throughout life and affect a high number of senior citizens.3
  • Fungal infections cause about half of all nail disorders.4 They are more common in toenails because the toes are confined in a warm, moist, weight-bearing environment.
  • Melanoma, the deadliest form of skin cancer, can grow under the nail in rare cases. Such melanomas may be mistaken for injuries, so consult a board-certified dermatologist if a dark-colored streak appears within your nail plate, if nail discoloration does not gradually improve or if the size of the discolored area increases over time.5
  • Other common nail problems include:
    • White spots after an injury to the nail.
    • Vertical lines, known as splinter hemorrhages, under the nails caused by nail injury or certain drugs and diseases.
    • Bacterial or yeast infections, most often due to injury, poor skin hygiene, nail biting, finger sucking or frequent exposure to water.
    • Ingrown toenails, caused by improper nail trimming, poor stance, digestive problems or tight shoes.
  • Do not try to self-treat ingrown toenails, especially if they are infected. See a board-certified dermatologist.
  • Nail problems are more common in those with diabetes or poor circulation. At the first sign of a problem, see a board-certified dermatologist.

Tips for keeping nails healthy

  • Keep nails clean and dry to prevent bacteria from collecting under the nail.
  • Cut your fingernails and toenails straight across and rounded slightly in the center. This will keep your nails strong and help you avoid ingrown toenails.
  • When toenails are thick and difficult to cut, soak feet in warm salt water (one teaspoon of salt per pint of water) for five to 10 minutes, and then apply urea or lactic acid cream. This softens the nails, making them easier to trim.
  • Wear proper-fitting shoes and alternate shoes on a regular basis. Tight shoes can cause ingrown toenails.
  • Do not bite your fingernails; this can transfer infectious organisms between your fingers and mouth. Nail biting also can damage the skin around your fingers, allowing infections to enter.
  • Apply a cream to moisturize your nails, especially after removing nail polish, since most polish removers contain chemicals that dry the nails.
  • If you want to wear a bright red or orange polish, prevent discoloration by applying an extra layer of base coat. If your nails become yellowed and discolored from the polish, they should return to their normal color over several weeks if the same polish is not reapplied.

Nail salon safety

  • While most nail salons follow strict sanitation guidelines6, consumers should check to make sure that the salon, the manicure stations, the footbaths and the tools are clean, and that the technicians wash their hands between clients.7-8 Consumers who get frequent manicures and pedicures should bring their own tools to the salon.
  • Don’t let a nail technician cut or push back your cuticle. It may allow an infection to develop.
  • Do not wear artificial nails to cover up nail problems, as this may make those problems worse. Artificial nails are not recommended for people who are prone to fungal infections or have brittle nails. People with healthy nails may wear artificial nails, but they should not be worn continuously.
  • Don’t shave your lower legs for at least 24 hours before you get a pedicure. If you nick yourself while shaving, a pedicure could put you at risk for an infection.
  • If you experience itching, burning or any type of allergic reaction to a nail cosmetic, see a board-certified dermatologist.

More information

Tips for healthy nails
Nail fungus
Manicure and pedicure safety
Gel manicures: Tips for healthy nails
Artificial nails: Dermatologists’ tips for reducing nail damage
How to stop biting your nails


1. Yaemsiri S, Hou N, Slining MM, He K. Growth rate of human fingernails and toenails in healthy American young adults. J Eur Acad Dermatol Venereol. 2010 Apr;24(4):420-3.

2. Cashman MW, Sloan SB. Nutrition and nail disease. Clin Dermatol. 2010 Jul-Aug;28(4):420-5.

3. Abdullah L, Abbas O. Common nail changes and disorders in older people: Diagnosis and management. Can Fam Physician. 2011 Feb;57(2):173-81.

4. Ghannoum MA, Hajjeh RA, Scher R, Konnikov N, Gupta AK, Summerbell R, Sullivan S, Daniel R, Krusinski P, Fleckman P, Rich P, Odom R, Aly R, Pariser D, Zaiac M, Rebell G, Lesher J, Gerlach B, Ponce-De-Leon GF, Ghannoum A, Warner J, Isham N, Elewski B. A large-scale North American study of fungal isolates from nails: the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol. 2000 Oct;43(4):641-8.

5. Kottschade LA, Grotz TE, Dronca RS, Salomao DR, Pulido JS, Wasif N, et al. Rare presentations of primary melanoma and special populations: a systematic review. Am J Clin Oncol. 2014 Dec;37(6):635-41

6. U.S. Department of Labor - Occupational Safety and Health Administration. Stay Healthy and Safe While Giving Manicures and Pedicures; 2012.

7. Stout JE, Gadkowski LB, Rath S, Alspaugh JA, Miller MB, Cox GM. Pedicure-associated rapidly growing mycobacterial infection: an endemic disease. Clin Infect Dis. 2011 Oct;53(8):787-92.

8. Chang RM, Hare AQ , Rich P. Treating cosmetically induced nail problems. Dermatologic therapy 2007;20:54-9.

Psoriasis

  • Psoriasis is a chronic inflammatory disease of the immune system. It mostly affects the skin and joints, but it also may affect the fingernails, the toenails, the soft tissues of the genitals and the inside of the mouth.
  • Psoriasis and psoriatic arthritis can be associated with other diseases and conditions, including diabetes, cardiovascular disease and depression.1
  • See a board-certified dermatologist for the successful diagnosis and treatment of psoriasis.

Psoriasis facts

  • Psoriasis is a serious medical condition.
  • Approximately 7.5 million people in the United States have psoriasis.1
  • Psoriasis occurs in all age groups but is primarily seen in adults, with the highest proportion between ages 45 and 64.2
  • Up to 40 percent of people with psoriasis experience joint inflammation that produces symptoms of arthritis. This condition is called psoriatic arthritis.3-5
  • Psoriasis usually occurs on the scalp, knees, elbows, hands and feet.
  • Approximately 80 percent of those affected with psoriasis have mild to moderate disease, while 20 percent have moderate to severe psoriasis affecting more than 5 percent of the body surface area.1
  • The most common form of psoriasis, affecting about 80 to 90 percent of psoriasis patients, is plaque psoriasis. It is characterized by patches of raised, reddish skin covered with silvery-white scale.1
  • There are other forms of psoriasis, including inverse, erythrodermic, pustular, guttate and nail disease.1
  • Psoriasis is not contagious.
  • In 2013, the total direct cost of treatment associated with psoriasis was estimated to be between $51.7 billion and $63.2 billion.6

Comorbidities associated with psoriasis

  • The incidence of Crohn’s disease and ulcerative colitis, two types of inflammatory bowel disease, is 3.8 to 7.5 times greater in psoriasis patients than in the general population.7-8
  • Patients with psoriasis also have an increased incidence of lymphoma,9-11 heart disease,12-13 obesity,14-15 type II diabetes16 and metabolic syndrome17 compared to the general population.
  • Depression and suicide,18 smoking,19-21 and alcohol consumption21 are also more common in psoriasis patients than in the general population.
    • The prevalence of depression in patients with psoriasis may be higher than 50 percent. Studies have shown that psoriasis patients experience physical and mental disability just like patients with other chronic illnesses such as cancer, arthritis, hypertension, heart disease and diabetes.22-23
  • Psoriasis can have a substantial psychological and emotional impact on patients.

Treatment options for psoriasis

  • Topical treatments are helpful for mild to moderate psoriasis but do not tend to be effective for treating moderate to severe psoriasis.23
    • Topical treatments can sometimes be used together with other medications.23
    • Topical corticosteroids are available in many strengths and formulations.23
  • Psoriasis patients with moderate to severe psoriasis can be treated with traditional systemic medications, which work throughout the body; biologic agents, which also work throughout the body, targeting specific parts of your immune system; or phototherapy, which utilizes UV light.24-26
  • In cases of more extensive psoriasis, topical agents may be used in combination with phototherapy, or traditional systemic or biologic medications.24-26
  • Since biologic therapies target the immune system, it is important to prevent infections during therapy. Patients need to be monitored and evaluated periodically.26-27
  • A board-certified dermatologist can evaluate your treatment options, including new and emerging therapies, and help you determine which treatment is best for you.

More information

Psoriasis
Psoriasis video library


1. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008 May;58(5):826-50.

2. American Academy of Dermatology/Milliman. Burden of Skin Disease. 2017. www.aad.org/BSD.

3. National Institutes of Health /NIAMS http://www.niams.nih.gov/Health_ Info/Psoriasis/default.asp (last accessed June 1, 2013).

4. National Psoriasis Foundation - http://www.psoriasis.org/about/ (last accessed June 1, 2013).

5. Gottlieb A, Korman NJ, Gordon KB, Feldman SR et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol 2008 May;58(5):851-64

6. Brezinski EA, Dhillon JS, Armstrong AW. Economic Burden of Psoriasis in the United States: A Systematic Review. JAMA Dermatol 2015; Published online January 07, 2015. doi:10.1001/jamadermatol.2014.3593.

7. Najarian DJ, Gottlieb AB. Connections between psoriasis and Crohn’s disease. Journal of the American Academy of Dermatology 2003; 48: 805- 21; quiz 22-4.

8. Churton SE, Doud K and Korman NJ. Comorbidities of psoriasis. Expert Review of Dermatology. 2013: 8(3), 277-290.

9. Gelfand JM, Shin DB, Neimann AL, Wang X, Margolis DJ , Troxel AB. The risk of lymphoma in patients with psoriasis. J Invest Dermatol 2006;126:2194-201.

10. Gelfand JM, Berlin J, Van Voorhees A, Margolis DJ. Lymphoma rates are low but increased in patients with psoriasis: results from a population-based cohort study in the United Kingdom. Arch Dermatol 2003;139:1425-9.

11. Shiba M, Kato T, Funasako M, Nakane E, Miyamoto S, Izumi T et al. Association between psoriasis vulgaris and coronary heart disease in a hospital-based population in Japan. 2016. PloS one. 2016; 11(2), e0149316.

12. Gelfand JM, Neimann AL, Shin DB et al. Risk of myocardial infarction in patients with psoriasis. JAMA 2006; 296: 1735-41

13. Neimann AL, Shin DB, Wang X et al. Prevalence of cardiovascular risk factors in patients with psoriasis. Journal of the American Academy of Dermatology 2006; 55: 829-35

14. Setty AR, Curhan G , Choi HK. Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses’ Health Study II. Arch Intern Med 2007;167:1670-5.

15. Sterry W, Strober BE , Menter A. Obesity in psoriasis: the metabolic, clinical and therapeutic implications. Report of an interdisciplinary conference and review. Br J Dermatol 2007;157:649-55.

16. Qureshi AA, Choi HK, Setty AR , Curhan GC. Psoriasis and the risk of diabetes and hypertension: a prospective study of US female nurses. Arch Dermatol 2009;145:379-82.

17. Gisondi P, Tessari G, Conti A et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study. The British Journal of Dermatology 2007; 157: 68-73.

18. Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol 2010;146:891-5.

19. Herron MD, Hinckley M, Hoffman MS, Papenfuss J, Hansen CB, Callis KP et al. Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol 2005;141:1527-34.

20. Armstrong AW, Harskamp CT, Dhillon JS, and Armstrong EJ.Psoriasis and smoking: a systematic review and meta‐analysis. British journal of dermatology. 2014. 170(2), 304-314.

21. Al‐Jefri K, Newbury‐Birch D, Muirhead, CR, Gilvarry E, Araújo‐Soares V et al. High prevalence of alcohol use disorders in patients with inflammatory skin diseases. British journal of dermatology. July 2017. http://dx.doi.org/10.1111/bjd.15497.

22. Dowlatshahi, E. A., Wakkee, M., Arends, L. R., & Nijsten, T. (2014). The prevalence and odds of depressive symptoms and clinical depression in psoriasis patients: a systematic review and meta-analysis. Journal of Investigative Dermatology, 134(6), 1542-1551

23. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 3. Guidelines of care for the treatment of psoriasis with topical therapies. J Am Acad Dermatol 2009 April; 60(4): 643-659

24. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, et al. Guidelines of care for the for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol 2010;62:114-35.

25. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol 2009;61:451-85.

26. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB,et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008 May;58(5):826-50.

27. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Leonardi CL, Lim HW, Van Voorhees AS, Beutner KR, Ryan C, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis Section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: Case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011 Jul;65(1):137-74

Rosacea

  • Rosacea is a common skin disease that affects 16 million Americans.1-3
  • Although there is no cure for rosacea, proper treatment can help control the condition.
  • See a board-certified dermatologist for the diagnosis and treatment of rosacea.

Rosacea facts

  • While people of all ages and races can develop rosacea, it is most common in the following groups:
    • People between age 30 and 60.4
    • Individuals with fair skin, blond hair and blue eyes.4-5
    • Women, especially during menopause.4
    • Those with a family history of rosacea.5
  • In 2013, the costs associated with the treatment and lost productivity among those who sought medical care for rosacea was $243 million.6
    • More than 1.6 million people sought treatment for rosacea in 2013.6
    • The total medical cost of treating rosacea was $165 million, for an average of $102.26 per treated patient.6
    • The lost productivity among patients and caregivers due to rosacea was $78 million.6

Symptoms

  • Common signs and symptoms of rosacea include:
    • Redness across the nose and cheeks, which may spread to the chin, forehead or ears.
    • Acne-like breakouts.
    • Thin, reddish-purple veins.
    • Skin that feels hot, tender, sore or easily irritated.
  • In some rosacea patients, the affected skin may grow thick due to enlargement of the oil glands.
    • This is more common in men than women.
    • When this occurs on the nose, it is known as rhinophyma.
  • For some patients, rosacea may get worse over time.
  • Rosacea also may affect the eyes. The symptoms of this condition, known as ocular rosacea, include:
    • Bloodshot or watery eyes.
    • Eyes that feel dry, itchy, irritated or gritty.
    • Burning or stinging in the eyes.
    • Blurry vision.
    • Sensitivity to light.

Treatment

  • Treatment from a board-certified dermatologist can help control rosacea and prevent it from getting worse.
  • A board-certified dermatologist can evaluate your condition and help you determine the best treatment plan for you.
  • Rosacea treatment may include topical or oral antibiotics, other topical medications, or laser procedures.
    • Thickened skin may be treated with lasers, dermabrasion or electrocautery.
  • It is especially important to seek treatment for ocular rosacea, which may worsen and interfere with eyesight.

Tips for managing rosacea

  • Identify and avoid your triggers. Several factors, including spicy foods, alcohol and hot beverages, may trigger rosacea flare-ups. Dermatologists suggest identifying your triggers by keeping a journal documenting your rosacea flare-ups and your exposure to common triggers. Once you’ve identified your triggers, try to avoid them if you can.
  • Protect your skin from the sun by:
    • Seeking shade, especially between the hours of 10 a.m. and 2 p.m.
    • Wearing protective clothing, such as a lightweight long-sleeved shirt, pants, a wide-brimmed hat and sunglasses.
    • Using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher. Look for a sunscreen that contains zinc oxide or titanium dioxide, which are the least irritating to skin with rosacea. When you’re outside, make sure to reapply sunscreen every two hours.
  • Avoid overheating, which may trigger rosacea.
  • Protect your skin from cold temperatures and wind, which also may cause rosacea to flare.
  • Try to avoid stress, another common rosacea trigger.
  • Keep your skin care routine simple:
    • Avoid cosmetic and personal care products that contain alcohol.
    • Don’t use too many products.
    • Avoid rubbing, scrubbing or massaging your face.
    • Shield your face when using hairspray.

More information

Rosacea


1.Steinhoff, M., Schauber, J., and Leyden, J.J. New insights into rosacea pathophysiology: a review of recent findings. J Am Acad Dermatol. 2013; 69: S15–S26

2. Elewski, B.E., Draelos, Z., Dréno, B., Jansen, T., Layton, A., and Picardo, M. Rosacea - global diversity and optimized outcome: proposed international consensus from the Rosacea International Expert Group. J Eur Acad Dermatol Venereol. 2011; 25: 188–200

3. Okhovat, J.-P. and Armstrong, A.W. Updates in rosacea: epidemiology, risk factors, and management strategies. Curr Dermatol Rep. 2014; 3: 23–28

4.Rosacea. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/rosacea#tab-risk.

5. Abram K, Silm H, Maaroos H-I and Oona M. Risk factors associated with rosacea. Journal of the European Academy of Dermatology and Venereology. 2010; 24 (5): 565-571

6. American Academy of Dermatology/Milliman. Burden of Skin Disease. 2017. www.aad.org/BSD

Skin cancer

  • Everyone is at risk for skin cancer. In fact, at least one in five Americans will develop skin cancer during their lifetime.1-2
  • You can prevent and detect skin cancer:
    • Prevent: Seek shade, cover up and wear sunscreen.
    • Detect: Look for new or changing spots on your skin.
    • Live: See a board-certified dermatologist if you notice any new or suspicious spots on your skin, or anything changing, itching or bleeding.
  • Visit SpotSkinCancer.org to learn how to perform a skin self-exam, download a body mole map for tracking changes on your skin and find free SPOTme® skin cancer screenings in your area.

Types of skin cancer

Basal cell carcinoma and squamous cell carcinoma

  • Collectively referred to as nonmelanoma skin cancers, basal cell carcinoma and squamous cell carcinoma are the most common forms of skin cancer.
  • NMSCs arise within the top layer of the skin. They can appear on any part of the body but are most frequently found on sun-exposed areas like the face, ears, bald scalp, shoulders and neck.
  • BCC frequently appears as a pearly bump, while SCC often looks like a rough red scaly area or a sore that heals and returns.
  • Although NMSC spreads slowly, it can lead to disfigurement if left untreated.

Melanoma

  • Melanoma is the deadliest form of skin cancer.
  • It may suddenly appear without warning, but it also can develop from or near an existing mole.
  • Melanoma can occur anywhere on the body but is most common on the upper back, torso, lower legs, head and neck.
  • Because melanoma may spread to lymph nodes and internal organs, early detection and treatment are essential.
  • New, rapidly growing moles, or moles that change, itch or bleed are often early signs of melanoma; these should be examined by a board-certified dermatologist.

Incidence rates

  • Skin cancer is the most common cancer in the United States.3-4
  • It is estimated that approximately 9,500 people in the U.S. are diagnosed with skin cancer every day.5-7
  • The majority of diagnosed skin cancers are NMSCs. Research estimates that NSMC affects more than 3 million Americans a year.5, 8
  • The overall incidence of BCC increased by 145 percent between 1976-1984 and 2000-2010, and the overall incidence of SCC increased 263 percent over that same period.9
    • Women had the greatest increase in incidence rates for both types of NMSC.9
    • NMSC incidence rates are increasing in people younger than 40.9
  • More than 1 million Americans are living with melanoma.10
  • It is estimated that 178,560 new cases of melanoma, 87,290 noninvasive (in situ) and 91,270 invasive, will be diagnosed in the U.S. in 2018.6-7
    • Invasive melanoma is projected to be the fifth most common cancer for men (55,150 cases) and the sixth most common cancer for women (36,120 cases) in 2018.6-7
  • Melanoma rates in the United States doubled from 1982 to 2011.4
  • Caucasians and men older than 50 have an increased risk of developing melanoma compared to the general population.6-7
  • Melanoma is the second most common form of cancer in females age 15-29.11
    • Melanoma incidence is increasing faster in females age 15-29 than in males of the same age group.12
  • Skin cancer can affect anyone, regardless of skin color.
    • Skin cancer in patients with skin of color is often diagnosed in its later stages, when it’s more difficult to treat.13
      • Research has shown that patients with skin of color are less likely than Caucasian patients to survive melanoma.14
    • People with skin of color are prone to skin cancer in areas that aren’t commonly exposed to the sun, like the palms of the hands, the soles of the feet, the groin and the inside of the mouth. They also may develop melanoma under their nails.13

Mortality rates

  • On average, one American dies of melanoma every hour. In 2018, it is estimated that 9,320 deaths will be attributed to melanoma — 5,990 men and 3,330 women.6-7
  • The vast majority of skin cancer deaths are from melanoma.6

Risk factors

  • Exposure to ultraviolet light, from the sun and indoor tanning devices, is the most preventable risk factor for all forms of skin cancer.
  • Research indicates that UV light from the sun and tanning beds can both cause melanoma and increase the risk of a mole progressing to melanoma.15
  • Caucasians have the highest risk of developing melanoma.6-7
  • Although BCC and SCC can occur at any age, the incidence rate increases as patients get older.16-17
  • Melanoma can strike anyone, but there is an increased risk for individuals who have:             
    • More than 50 moles, large moles or atypical (unusual) moles.18
    • A blood relative (parent, sibling, child, aunt, uncle, cousin) who has had melanoma.
    • Sun-sensitive skin (i.e., tendency to sunburn easily, red or blond hair, or blue or green eyes).6
    • A history of excessive sun exposure (including sunburns) or indoor tanning.6
    • A previous diagnosis of either melanoma or NMSC.18-22
    • A history of other cancers, such as breast or thyroid cancer.23-27
  • Individuals who have been diagnosed with either BCC or SCC are at increased risk for the development of future skin cancers, including melanoma.19
  • Using indoor tanning beds is known to increase the risk of melanoma and NMSC.28-29

Prevention/detection

  • Protecting your skin from ultraviolet light can reduce your risk of developing skin cancer. (See Sun safety.)
  • Skin cancer is highly treatable when detected early. If you notice any new or suspicious spots on your skin, or anything changing, itching or bleeding, see a board-certified dermatologist.

Treatment and survival

  • The annual cost of treating skin cancers in the U.S. is estimated at $8.1 billion — about $4.8 billion for NMSC and $3.3 billion for melanoma.3
  • Early detection of melanoma is essential; melanoma detected and treated in its early stages has a better prognosis than melanoma detected in its later stages.30-31    
    • The five-year survival rate for people whose melanoma is detected and treated before it spreads to the lymph nodes is 99 percent.6-7
    • The five-year survival rate for melanoma that spreads to nearby lymph nodes is 64 percent. The five-year survival rate for melanoma that spreads to distant lymph nodes and other organs is 23 percent.12
  • Early detection and treatment of NMSC is also important because the cancer may  spread and metastasize, leading to disfigurement or death.
  • Both BCC and SCC are highly treatable when detected early.32
  • Melanomas are removed surgically. Dermatologic surgeons take out the tumor as well as some of the surrounding skin. The amount of skin removed depends on the size and depth of the tumor.
  • Treatments for BCC and SCC include surgical approaches such as excision or Mohs micrographic surgery, electrodessication and curettage (which involves scraping the tumor off the skin and destroying any remaining cells with electric current), and cryosurgery (which involves freezing the tumor with liquid nitrogen), as well as nonsurgical methods such as radiation therapy, topical agents and photodynamic therapy.

Melanoma Monday

  • Since 1995, the Academy has designated the first Monday in May as Melanoma Monday®, which officially kicks off Skin Cancer Awareness Month.
  • The purpose of this day and month is to raise awareness of melanoma, the deadliest form of skin cancer, and to encourage the public to examine their skin for suspicious spots.

More information

SPOT Skin Cancer™
Skin cancer
Melanoma
Basal cell carcinoma
Squamous cell carcinoma


1. Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol. 2010 Mar;146(3):279-82.

2. Robinson JK. Sun Exposure, Sun Protection, and Vitamin D. JAMA 2005; 294: 1541-43.

3. Guy GP, Machlin SR, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the US, 2002-2006 and 2007-2011. Am J Prev Med. 2015;48:183–7.

4. Guy GP, Thomas CC, Thompson T, Watson M, Massetti GM, Richardson LC. Vital signs: Melanoma incidence and mortality trends and projections—United States, 1982–2030. MMWR Morb Mortal Wkly Rep. 2015;64(21):591-596.

5. Rogers HW, Weinstock MA, Feldman SR, Coldiron BM. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the US population. JAMA Dermatol. Published online April 30, 2015.

6. American Cancer Society. Cancer Facts and Figures 2018. Atlanta: American Cancer Society; 2018

7. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018; doi: 10.3322/caac.21442.

8. American Academy of Dermatology/Milliman. Burden of Skin Disease. 2017. www.aad.org/BSD.

9. Muzic, JG et al. Incidence and Trends of Basal Cell Carcinoma and Cutaneous Squamous Cell Carcinoma: A Population-Based Study in Olmstead County, Minnnesota, 2000-2010. Mayo Clin Proc. Published Online May 15, 2017. http://dx.doi.org/10.1016/j.mayocp.2017.02.015

10. SEER Cancer Stat Facts: Melanoma of the Skin. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/statfacts/html/melan.html

11. Surveillance, Epidemiology, and End Results (SEER) program 18 registries. Data run July 25, 2018.

12. Noone AM, Howlader N, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.

13. Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, Roberts WE, Draelos ZD, Bhushan R, Taylor SC, Lim HW. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-62.

14. Dawes SM et al. Racial disparities in melanoma survival. J Am Acad Dermatol. 2016 Nov; 75(5):983-991.

15. Shain, AH et al. The genetic evolution of melanoma from precursor lesions. N Engl J Med 2015; 373:1926-1936.

16. Alam M, Ratner D. Cutaneous squamous-cell carcinoma. N Engl J Med 2001; 344(13):975-983.

17. Rubin AI, Chen EH, Ratner D. Basal-cell carcinoma. N Engl J Med 2005; 353(21):2262-9.

18. Cyr PR. Atypical moles. Am Fam Physician. 2008 Sep 15;78(6):735-40.

19. Flohil SC, van der Leest RJ, Arends LR, de Vries E, Nijsten T. Risk of subsequent cutaneous malignancy in patients with prior keratinocyte carcinoma: a systematic review and meta-analysis. Eur J Cancer. 2013 Jul;49(10):2365-75.

20. Wheless L, Black J, Alberg AJ. Nonmelanoma skin cancer and the risk of second primary cancers: a systematic review. Cancer Epidemiol Biomarkers Prev. 2010 Jul;19(7):1686-95.

21. Rees JR, Zens MS, Gui J, Celaya MO, Riddle BL, Karagas MR. Non melanoma skin cancer and subsequent cancer risk. PLoS One. 2014 Jun 17;9(6):e99674.

22. Song F, Qureshi AA, Giovannucci EL, Fuchs CS, Chen WY, Stampfer MJ, Han J. Risk of a second primary cancer after non-melanoma skin cancer in white men and women: a prospective cohort study. PLoS Med. 2013;10(4):e1001433.

23. Grenader T, Goldberg A, Shavit L. Second cancers in patients with male breast cancer: a literature review. J Cancer Surviv. 2008;2(2):73-78.

24. Satram-Hoang S, Ziogas A, Anton-Culver H. Risk of second primary cancer in men with breast cancer. Breast Cancer Res. 2007;9(1):R10.

25. Auvinen A, Curtis R, Ron E. Risk of subsequent cancer following breast cancer in men. J Natl Cancer Inst. 2002;94(17):1330-1332.

26. Canchola A, Horn-Ross P, Purdie D. Risk of secondary primary malignancies in women with papillary thyroid cancer. Am J Epidemiol. 2006;163(6):521-527.

27. Beaugerie, L., Carrat, F., Colombel, J. F., Bouvier, A. M., Sokol, H., Babouri, A., ... & De Gramont, A. (2013). Risk of new or recurrent cancer under immunosuppressive therapy in patients with IBD and previous cancer. Gut, gutjnl-2013.

28. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012 Jul 24;345:e4757

29. Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ. 2012 Oct 2;345:e5909

30. Coit DG, Thompson JA, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE 3rd, et al. National Comprehensive Cancer Network. Melanoma, version 4.2014. J Natl Compr Canc Netw. 2014 May;12(5):621-9.

31. Bichakjian CK, Halpern AC, Johnson TM, Foote Hood A, Grichnik JM, Swetter SM, et al. American Academy of Dermatology guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol. 2011 Nov;65(5):1032-47.

32. Neville JA, Welch E, Leffell DJ. Management of nonmelanoma skin cancer in 2007. Nat Clin Pract Oncol 2007; 4(8):462-9.


Skin of color

  • Conditions affecting skin pigmentation, including melasma and hyperpigmentation, are common in patients with skin of color.
  • People with skin of color can get skin cancer, so it’s important for them to regularly perform skin self-exams to detect the disease early, when it’s most treatable.
  • To reduce their risk of skin cancer, it’s important for people with skin of color to protect their skin from the sun’s harmful ultraviolet rays by seeking shade, wearing protective clothing, and using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.

Melasma

  • Melasma is a common condition that causes brown patches to appear on the skin.
    • It usually appears on the cheeks, on the upper lip and between the eyebrows.
  • This condition is more common in people with skin of color because they have more active pigment-producing cells, called melanocytes, than those with lighter skin.1
  • Melasma occurs most often in women who have Latina, African or Asian ancestry.2
    • It may be associated with pregnancy, birth control pills or estrogen replacement therapy.3
    • It also may occur in men.4
  • A board-certified dermatologist can treat melasma that doesn’t go away on its own.
    • Prescription topical treatments can help the condition fade.
    • In-office procedures like chemical peels, laser treatment and microdermabrasion also may be helpful.
  • To prevent melasma from becoming worse, patients should protect their skin from the sun.

Hyperpigmentation

  • People with skin of color are prone to post-inflammatory hyperpigmentation, a condition in which dark marks appear on the skin as it heals from damage or trauma.5
    • While a board-certified dermatologist can treat PIH by prescribing medication or performing an in-office procedure, such a chemical peel or microdermabrasion, this condition can be difficult to treat.
    • Over-the-counter products usually do not improve PIH. In some cases, these products may make the condition worse.
  • Certain medications also may cause skin discoloration or dark patches, especially in people of African or Latino descent.6
    • Even if you experience skin discoloration, do not stop taking your medication without talking to your doctor.
  • Sun damage may lead to hyperpigmentation or make it worse, so it’s important for people with skin of color to protect their skin from the sun.
  • Chemical peels may cause pigmentation problems in patients with skin of color if the procedure is not performed by a properly trained physician.
    • People with skin of color who are considering a chemical peel should see a board-certified dermatologist who specializes in treating darker skin tones.

Skin cancer

  • Skin cancer can affect anyone, regardless of skin color.
    • Skin cancer is the most common cancer in the United States.7-8  In fact, it is estimated that one in five Americans will develop skin cancer in their lifetime.9-10
  • Skin cancer in patients with skin of color is often diagnosed in its later stages, when it’s more difficult to treat.1
    • Research has shown that patients with skin of color are less likely than Caucasian patients to survive melanoma, the deadliest form of skin cancer.11
  • People with skin of color are prone to skin cancer in areas that aren’t commonly exposed to the sun, like the palms of the hands, the soles of the feet, the groin and the inside of the mouth.1
  • People with skin of color also may develop melanoma under their nails.1
    • While dark streaks or bands on the nails are common in people with skin of color, it’s important to see a board-certified dermatologist if you notice any of the following:
      • Skin around the base of the nail getting progressively darker
      • Changes in the size, shape or color of an existing band or streak
      • A new, single dark band
  • It’s important for all patients to regularly examine their skin for signs of skin cancer.
    • Patients with skin of color should be sure to check their entire bodies, including areas that aren’t usually exposed to the sun, and ask a partner to examine hard-to-see areas like the back.
    • If you notice any new or suspicious spots on your skin, or anything changing, itching or bleeding, see a board-certified dermatologist.

More information

Melasma
SPOT Skin Cancer™
Skin cancer
Melanoma


1. Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, Roberts WE, Draelos ZD, Bhushan R, Taylor SC, Lim HW. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-62.

2. Handel AC, Miot LD, Miot HA. Melasma: a clinical and epidemiological review. An Bras Dermatol. 2014;89(5):771-82.

3. Ortonne JP, Arellano I, Berneburg M, Cestari T, Chan H, Grimes P, Hexsel D, Im S, Lim J, Lui H, Pandya A. A global survey of the role of ultraviolet radiation and hormonal influences in the development of melasma. J Eur Acad Dermatol Venereol. 2009;23(11):1254.

4. Sarkar R, Puri P, Jain RK, Singh A, Desai A. Melasma in men: a clinical, aetiological and histological study. J Eur Acad Dermatol Venereol. 2010;24(7):768-72.

5. Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol. 2010;3(7):20.

6. Taylor SC, Grimes PE, Lim J, et al. Postinflammatory Hyperpigmentation. J Cutan Med Surg. 2009;13:183–191

7. Guy GP, Machlin SR, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the US, 2002-2006 and 2007-2011. Am J Prev Med. 2015;48:183–7.

8. Guy GP, Thomas CC, Thompson T, Watson M, Massetti GM, Richardson LC. Vital signs: Melanoma incidence and mortality trends and projections—United States, 1982–2030. MMWR Morb Mortal Wkly Rep. 2015;64(21):591-596.

9. Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol. 2010 Mar;146(3):279-82.

10. Robinson JK. Sun Exposure, Sun Protection, and Vitamin D. JAMA 2005; 294: 1541-43.

11. Dawes SM et al. Racial disparities in melanoma survival. J Am Acad Dermatol. 2016 Nov; 75(5):983-991.

Sun safety

  • One in five Americans will develop skin cancer during their lifetime. Sun exposure is the most preventable risk factor for skin cancer, including melanoma, the deadliest form of skin cancer.1-3
  • To protect your skin from the sun, seek shade, wear protective clothing and use a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.
  • To detect skin cancer early, when it’s most treatable, perform regular skin self-exams, and see a board-certified dermatologist if you notice new or suspicious spots on your skin, or anything changing, itching, or bleeding.

Ultraviolet radiation

  • Sunlight consists of two types of harmful ultraviolet rays that reach the earth — ultraviolet A rays and ultraviolet B rays, both of which can cause skin cancer.
    • UVA rays (“aging rays”) can prematurely age your skin, causing wrinkles and age spots. They can pass through window glass.
    • UVB rays (“burning rays”) are the primary cause of sunburn. They are blocked by window glass.
  • The sun emits harmful UV rays year-round. Even on cloudy days, UV rays can penetrate the skin.
    • On a cloudy day, up to 80 percent of the sun’s UV rays can pass through the clouds.4
  • UV radiation from the sun and artificial sources, such as tanning beds and sun lamps, has been declared to be a known carcinogen (cancer-causing substance) by the U.S. Department of Health and Human Services and the World Health Organization’s International Agency of Research on Cancer panel.5
  • There is no safe way to tan. Every time you tan, you damage your skin. As this damage builds, you speed up the aging of your skin and increase your risk for all types of skin cancer.

How to protect your skin from the sun

The American Academy of Dermatology recommends that everyone:

  • Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 2 p.m. If your shadow is shorter than you are, seek shade.6
  • Wear protective clothing, such as a lightweight long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, when possible.
  • Generously apply a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher. Broad-spectrum sunscreen provides protection from both UVA and UVB rays.
    • Use sunscreen whenever you are going to be outside, even on cloudy days.
    • Apply enough sunscreen to cover all exposed skin. Most adults need about 1 ounce — or enough to fill a shot glass — to fully cover their body.
    • Don’t forget to apply to the tops of your feet, your neck, your ears and the top of your head.
  • When outdoors, reapply sunscreen every two hours, or after swimming or sweating.
  • Use extra caution near water, snow and sand, as they reflect the damaging rays of the sun, which can increase your chance of sunburn.
    • Snow reflects 80 percent of the sun’s rays, and sand reflects 25 percent of the sun’s rays.4
  • Avoid tanning beds. Ultraviolet light from tanning beds can cause skin cancer and premature skin aging. (See Indoor tanning.)
  • Consider using a self-tanning product if you want to look tan, but continue to use sunscreen with it.

What to look for in a sunscreen

  • The U.S. Food and Drug Administration requires sunscreen labels to provide consumers with information about whether a sunscreen will protect against skin cancer in addition to sunburn. Labels also indicate whether the product is water-resistant.
  • The best sunscreen is one you will use again and again. The type of sunscreen you select is a matter of personal choice and may vary depending what part of your body you’re protecting.
    • Creams are best for dry skin and the face.
    • Gels are good for hairy areas, such as the scalp or male chest.
    • Sticks are good to use around the eyes.
    • Sprays are sometimes preferred by parents since they are easy to apply to children.
      • Current FDA regulations on testing and standardization do not pertain to spray sunscreens. The agency continues to evaluate these products to ensure safety and effectiveness.
      • Make sure to spray enough sunscreen to cover all exposed skin and rub it in to ensure even coverage.
      • Never spray sunscreen around or near your face or mouth. Instead, spray sunscreen on your hands and then apply to the face.
    • There also are sunscreens made for specific uses, such as on sensitive skin or on babies 6 months or older.
  • There are two types of sunscreens: chemical and physical.
    • Chemical sunscreens work like a sponge, absorbing the sun’s rays.
      • They contain one or more of the following active ingredients: oxybenzone, avobenzone, octisalate, octocrylene, homosalate and octinoxate.
      • These formulations tend to be easier to rub into the skin without leaving a white residue.
    • Physical sunscreens work like a shield, sitting sit on the surface of the skin and deflecting the sun’s rays.
      • They contain the active ingredients zinc oxide and/or titanium dioxide.
      • Individuals with sensitive skin may prefer this type of sunscreen.
    • The FDA has approved the active ingredients in both types of sunscreen as safe and effective.
      • If you are concerned about certain sunscreen ingredients, you can select a formula that contains different active ingredients.
      • As long as your sunscreen is broad-spectrum, water-resistant and has an SPF 30 or higher, it can effectively protect you from the sun.

  • Some sunscreen products are also available in moisturizers and cosmetics. While these products are convenient, they also need to be reapplied in order to achieve the best sun protection.
  • Sunscreen also may be available in combination with an insect repellant. The Academy recommends that these products be purchased and used separately; sunscreen needs to be applied generously and often, whereas insect repellant should be used sparingly and much less frequently.
  • Sunscreen use should be avoided if possible in babies younger than 6 months.
    • The best way to protect infants from the sun's rays is to keep them in the shade as much as possible, in addition to dressing them in lightweight long sleeves, pants, a wide-brimmed hat and sunglasses.
  • Broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher may be applied to the exposed skin of babies and toddlers 6 months or older.
    • Sunscreens that use the ingredients zinc oxide or titanium dioxide, or special sunscreens made for infants or toddlers may cause less irritation to their sensitive skin.

How to use sunscreen

  • Use enough sunscreen to generously coat all skin that will be not be covered by clothing.
    • One ounce, enough to fill a shot glass, is considered the amount needed to cover the exposed areas of the body. Adjust the amount of sunscreen applied depending on body size.
    • Don’t forget to apply to tops of your feet, your neck, your ears and the top of your head.
    • Most people only apply 25-50 percent of the recommended amount of sunscreen.7
  • Apply sunscreen to dry skin 15 minutes before going outdoors.
  • Skin cancer also can form on the lips. To protect your lips, apply a lip balm or lipstick that contains sunscreen with an SPF of 30 or higher.
  • If sunscreen is used every day and in the correct amount, a bottle should not last long. Here are some guidelines to determine if an unfinished bottle of sunscreen is still effective for use:
    • The FDA requires that all sunscreens retain their original strength for at least three years.
    • Some sunscreens include an expiration date. If the expiration date has passed, throw out the sunscreen.
    • If the sunscreen does not have an expiration date, write the date the sunscreen was purchased on the bottle — that way you’ll know when to throw it out.
    • Look for visible signs that the sunscreen may no longer be good. Any obvious changes in the color or consistency of the product mean it’s time to purchase a new bottle.

More information

Prevent skin cancer
How to select a sunscreen
How to apply sunscreen
Sunscreen labels
Is sunscreen safe?


 

1. Guy GP Jr, Machlin SR, Ekwueme DU, Yabroff KR. Prevalence and costs of skin cancer treatment in the U.S., 2002-2006 and 2007-2011. Am J Prev Med. 2015 Feb;48(2):183-7.

2. American Cancer Society. Cancer Facts & Figures 2014. Atlanta: American Cancer Society 2014

3. Robinson, JK. Sun Exposure, Sun Protection and Vitamin D. JAMA 2005; 294: 1541-43.

4. Global Solar UV Index. World Health Organization. http://www.who.int/uv/ publications/en/UVIGuide.pdf.

5. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Report on carcinogens, 14th ed: Ultraviolet-radiation-related exposures. 2016. http://ntp.niehs.nih.gov/go/roc14

6. Holloway L. Atmospheric sun protection factor on clear days: its observed dependence on solar zenith angle and its relevance to the shadow rule for sun protection. Photochem Photobiol 1992;56:229-34.

7. Neale R, Williams G, Green A. Application patterns among participants randomized to daily sunscreen use in a skin cancer prevention trial. Arch Dermatol. 2002 Oct; 138, 1319-1325.

Teledermatology

  • Teledermatology involves using computers or mobile devices to provide remote dermatologic consultations.
  • The American Academy of Dermatology supports the appropriate use of telemedicine as a way to improve access to dermatologic care.
  • Before using a teledermatology service, patients should take steps to ensure that they’re receiving high-quality care from a board-certified dermatologist.

How is teledermatology used?

  • There are two main types of teledermatology:
    • Live interactive teledermatology involves a real-time video conference between the doctor and the patient.
    • Store-and-forward teledermatology involves the submission of photos and patient history to the dermatologist, who reviews the submission and reports back.
  • Board-certified dermatologists may use teledermatology to:
    • Provide remote evaluation and diagnosis of some conditions.
    • Determine whether a patient needs an in-person evaluation.
    • Provide consultation services to assist other physicians.
    • Provide follow-up care to their patients.
  • While teledermatology is a useful tool, not all dermatology services may be performed remotely.

How can patients make sure they're receiving the best possible care?

  • If possible, it’s best to seek teledermatology services from the health system that you utilize for other medical care.
    • This will allow you to work with your established health team, ensure that your provider has access to your medical records, and prevent duplication or fragmentation of care.
  • Before using a direct-to-consumer teledermatology service, ask the following questions:
    • Who will be providing my care? You should only receive a consultation from a board-certified dermatologist who is licensed in your state. Ask for the provider’s credentials; if a remote consultation service won’t provide those credentials, don’t use that service.
    • Can I choose my doctor? Only use teledermatology services that allow you to select the dermatologist of your choice for your consultation.
    • Can I submit my medical records? A quality teledermatology service should give you the opportunity to share your medical history.
    • Will I receive a record of my consultation? You should share this with your primary care provider or dermatologist.
    • Can I schedule an in-person appointment if necessary? Make sure the service has a plan in place to arrange for an office visit with a board-certified dermatologist in your area if your problem can’t be resolved remotely.
       
  • Visit aad.org/findaderm to find dermatologists in your area who offer teledermatology services.

More information

AAD Position Statement on Teledermatology
Be aware of who's providing your care

Vitamin D & UV exposure

  • Because ultraviolet rays from the sun and tanning beds can cause skin cancer, the American Academy of Dermatology does not recommend getting vitamin D from sun exposure or indoor tanning.1-6 A better alternative is getting vitamin D from a healthy diet that includes foods naturally rich in vitamin D, foods and beverages fortified with vitamin D, and/or vitamin D supplements.
  • To protect against UV-induced skin cancer, dermatologists recommend a comprehensive sun protection plan that includes seeking shade, wearing protective clothing, and applying a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.7-8
  • Anyone concerned about vitamin D deficiency should discuss their options with their doctor.

Vitamin D facts

  • Unprotected exposure to UV rays from the sun or indoor tanning devices is a known risk factor for the development of skin cancer, including melanoma, the deadliest form of skin cancer.3-8
  • The U.S. Department of Health and Human Services and the World Health Organization’s International Agency of Research on Cancer panel have declared UV radiation from the sun and artificial sources, such as tanning beds and sun lamps, to be a known carcinogen (cancer-causing substance).1,4
  • While vitamin D is critical for healthy bones, vitamin D intake may not lower cancer mortality.9-10
    • While some studies have suggested that vitamin D can reduce deaths from cancer and/or improve cancer survival, other studies have not been able to confirm these observations.11-12
  • The Institute of Medicine (now known as the National Academy of Medicine) concluded that the evidence for associating vitamin D status with health benefits other than bone health was inconsistent, inconclusive as to causality and insufficient to inform nutritional requirement.13-14
  • Based on currently available scientific evidence that supports a key role of calcium and vitamin D in skeletal health, the NAM’s Recommended Dietary Allowance* for vitamin D is:
    • 400 International Units for infants/children 0-1 years
    • 600 IU for children, teenagers and adults 1-70 years
    • 800 IU for adults 71+ years
  • Because the amount of vitamin D a person receives from the sun is inconsistent and increases the risk of skin cancer, the NAM’s RDA was developed based on a person receiving minimal or no sun exposure.

*The RDA is the intake that covers the needs of 97.5 percent of the healthy, normal population.

More information

Position statement on Vitamin D


1. U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Report on carcinogens, 11th ed: Exposure to sunlamps or sunbeds.

2. Melnikova VO, Ananthaswamy HN. Cellular and molecular events leading to the development of skin cancer. Mutat Res 2005; 571(1-2):91-106.

3. Whitmore SE, Morison WL, Potten CS, Chadwick C. Tanning salon exposure and molecular alterations. J Am Acad Dermatol 2001; 44:775-80.

4. International Agency for Research on Cancer, Working Group on artificial ultraviolet (UV) light and skin cancer. The association of use of sunbeds with cutaneous malignant melanoma and other skin cancer: A systematic review. Int J Cancer 2007; 120(5):1116-22.

5. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012 Jul 24;345:e4757

6. Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E, Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ. 2012 Oct 2;345:e5909

7. Van der Pols JC, Williams GM, Pandeya N, Logan V, Green AC. Prolonged prevention of squamous cell carcinoma of the skin by regular sunscreen use. Cancer Epidemiol Biomarkers Prev 2006; 15(12):2546-8.

8. Green AC, Williams GM, Logan V, Strutton GM. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol. 2011 Jan 20;29(3):257-63.

9. Freedman DM, Looker AC, Abnet CC, Linet MS, Graubard BI. Serum 25-hydroxyvitamin D and cancer mortality in the NHANES III study (1988- 2006). Cancer Res 2010;70(21):8587-97.

10. Pilz S, Kienreich K, Tomaschitz A, Ritz E, Lerchbaum E, Obermayer-Pietsch B, Matzi V, Lindenmann J, Marz W, Gandini S, Dekker JM. Vitamin d and cancer mortality: systematic review of prospective epidemiological studies. Anticancer Agents Med Chem. 2013 Jan 1;13(1):107-17.

11. Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Krstic G, Wetterslev J, Gluud C. Vitamin D supplementation for prevention of cancer in adults. Cochrane Database Syst Rev. 2014 Jun 23;6:CD007469.

12. Mondul AM, Weinstein SJ, Layne TM , Albanes D. Vitamin D and Cancer Risk and Mortality: State of the Science, Gaps, and Challenges. Epidemiologic reviews 2017:1-21.

13. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D from the Institute of Medicine: What Clinicians Need to Know. J Clin Endocrinol Metab Nov 29 2010 (epub ahead of print)

14. Institute of Medicine. 2011 Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press.