Get to know our dermatology experts
Dr. Hibler calls North Lake Tahoe home and sees patients at the practice’s Incline Village location. Specializing in medical, pediatric, surgical, and cosmetic dermatology, his approach as an osteopathic physician focuses on treating the whole person.
In private practice since 1997, Dr. Wallach treats patients at the practice’s Truckee location. He diagnoses a full range of dermatologic problems for both adults and children, specializes in medical and cosmetic dermatology, and is well known for treating many types of skin cancer. He is a strong proponent of patient education in his practice and is a contributing author to the upcoming book, The 21st Century Man. Dr. Wallach and his family live in the North Tahoe area.
J. Hibler, D.O.
Q: What are the top three common men’s health concerns that you want your patients to be aware of?
A: As a board-certified dermatologist and doctor of osteopathic medicine my natural bias centers on the concern for malignant melanoma, a deadly form of skin cancer. Recently I have been diagnosing about one male per week in our dermatology practice in Incline Village. If you had a chance to read our Q&A about skin cancer last month, I highly recommend making sure you are as educated about skin cancer as possible, and that article about America’s most common cancer is very informative. As far as overall health concerns, I think cardiovascular, mental, and prostate health are extremely important. I hear too many times that, “something has to kill me eventually,” and I counter with, why not try to stay healthy for as long as possible so that we can enjoy a high quality of life for the long-term? Keeping up with your age-appropriate screening guidelines is simple and easy and will improve your quality of life and extend your time on this earth.
Q: How different is men’s skin from women’s and how does that affect how men should care for their skin or what treatments they should seek?
A: It is not that different when it comes down to it. It is practically impossible for a pathologist to say whether a skin sample comes from a male or female. That said, we do know that based on self-reporting studies that men are much less likely to take skin cancer preventative measures such as wearing sunscreen and practicing safe sun protection measures. So back to my recommendation about reading our skin cancer awareness article where you can learn all about skin cancer including how to spot it, help prevent it, and treat it.
Q: Why are monthly skin cancer self-exams so important for men?
A: Most men don’t perform self-skin exams. This is a problem because melanoma can develop anywhere, even where the sun doesn’t reach, at any age, and on any skin type. People ask all the time why I examine their feet during a full skin cancer exam and my answer to make it relatable to most patients is, Bob Marley died from melanoma on his toe. I cannot emphasize enough the importance of self-skin exams, annual full skin exams with a board-certified dermatologist, and taking proactive preventative measures to protect your skin. Making these things should be a habit much like getting annual physicals and seeing your dentist once a year.
Adam Wallach, M.D.
Q: Do you have any tips and tricks for your male patients to remember the importance of daily sunscreen use?
A: The key to establishing a sunscreen ritual is firstly finding a product that feels good to you — not too heavy, not fragranced, blends with skin color, and is easy to use. To that end, I often recommend that men try different products, trying two at a time with one product applied on the left and the second product to the right. Which feels better? This way you can quickly sort through various products to find what suits you best. Clearly, a dark-skinned man with oily skin will need a different product than a fair-skinned man with drier skin. Often your dermatologist can provide you with samples to conduct this trial-and-error approach, or simply ask your dermatologist what he or she recommends. I listed my favorites in our skin cancer awareness article.
Next, keep the sunscreen beside your sink, in a place that you will see every morning when you come out of the shower or finish washing your face. Don’t place the tube in a drawer or share it with your partner. Additionally, one needs a simple and reproducible way to apply the product, so it is done the same way with the same amount each day. I like to use a dotting method whereby I dispense two generous pumps of my favorite product to my palm and then place a specified number of dots to various areas of the face, ears, and neck before rubbing it all in. This last recommendation will avoid having missed areas as well as globs of unblended product.
Most importantly, do this every day, at least on the face, regardless of the forecast or your schedule, because weather often changes, as do one’s plans — a cloudy day is suddenly balmy and that plan of not leaving the office can turn into a spontaneous outdoor lunch! Use an SPF of at least 30-50 and avoid SPF>50 as the Food and Drug Administration will be eliminating them soon and they provide only marginal added benefit often at the cost of feeling heavier. Assume that you are getting about half of the SPF on the label as those numbers are predicated on strict laboratory assessment of SPF that doesn’t approximate real-life usage.
I have a favorite facial sunscreen for everyday use when I go to the office and may step outside for a quick lunch and a weekend sport water-resistant sunscreen for both face and body that is a bit tackier to withstand the effects of sweating or water. If your total exposure will be more than two hours, please reapply your sunscreen. If you are swimming, consider reapplying every time you exit the water, as even a water-resistant product will sometimes not adhere or will be washed away more readily than expected. The tests conducted to attain a water-resistant label are performed with sunscreen applied in two coats and allowed to dry 20 min prior to testing — not how most folks apply sunscreen.
Finally, don’t forget that sunscreen is not a substitute for sun avoidance or sun-protective clothing. Protect your lips with a lip specific product that will adhere better than regular sunscreen, don a broad-brimmed hat, and grab your sunglasses.
Q: Historically, men have kept their skin care simple. But trends are showing a greater interest in pursuing healthier and younger-looking skin. What tips do you offer your patients to evaluate their skin care routine and select products and/or cosmetic dermatology procedures to care for their skin?
A: Let us first talk about cleansers and moisturizers. Some men, especially as they age, will discover that retaining moisture in the skin not only makes the skin feel better but makes it look more youthful too. A good product will provide emollient qualities that smooth the skin by acting like a glue that keeps adjacent keratinocytes (the cells of the epidermis) together, will have humectants (for example hyaluronic acid or urea) which help retain water, and have occlusive properties to diminish epidermal water loss. Note that moisturizers do not moisturize the skin per se – more accurately, they enhance barrier repair by supporting your skin’s natural restorative processes. The best time to apply them is immediately after a shower when the skin has absorbed lots of water. If you live in a sunny climate and routinely shower in the morning, find a sunscreen in a nice moisturizing base so that you will only need one product to do both jobs.
Unfortunately, the product options, like the myriad of sunscreen options, can be overwhelming. Your preference will depend largely on the type of skin you have and what feels good to you. At Skin Cancer & Dermatology Institute we offer a wide array of products that I like to recommend, so just ask me or any of our talented medical providers and cosmetic specialists for the best moisturizer for you. Experiment with products you already own or borrow some of your partner’s products. If a cream feels great when you first apply it but later in the day your skin feels dry, likely it’s too light or water-based lacking occlusive properties — try something a bit heavier. Most men will prefer oil-free moisturizers that are silicone based (often containing dimethicone) rather than oil-based as they will feel less oily and are more cosmetically elegant.
Finally, one of the simplest, least expensive, and most effective moisturizing agents available is Aquaphor®. It is inexpensive, nonallergenic, and decreases evaporative water loss better than almost anything else. The key to embracing this typically slippery product is to use small amounts applied to the palms and then to damp warm areas of the body.
As far as cleansers go, keep it simple, and again use what feels good. Because of the added sebum most men produce relative to women, men can use more typical soaps on the face without feeling dry. Do not get overzealous with scrubbing and rotating scrubbing brushes as you may damage the critical skin barrier that retains moisture. If your skin is dryer or more sensitive, consider a lipid free cleanser like Cetaphil® or CeraVe®.
What about creams that advertise to make you look younger? The truth is that cosmeceuticals are a multibillion-dollar market of products with incredibly enticing packaging that mostly have no well controlled studies to support their use. The number of antioxidant, botanical, anti-inflammatory, peptide and stem cell products is mind numbing. While many products make your skin feel good, they may just be functioning as expensive moisturizers rather than providing added benefits. For example, there has been a trend of promoting creams containing certain peptides or neuropeptides that mimic the effects of injectable botulinum toxin. The companies producing these products are careful to avoid claims although they make suggestions with creative word play that these creams might work as well as or like the injectable form of botulinum toxin, but there is no evidence to support this intimation. Another popular molecule being touted is Matrixyl™, which claims to produce increased levels of certain types of collagen. These peptides are classified as food and are likely incredibly safe, although their suggested effects are questionable. Over-the-counter cosmetics are not subject to the same testing rigor that FDA-approved products are. So, physicians and patients must determine if a product is worthy based on anecdotal evidence and small studies done in vitro (petri dish) on the end-product without validated testing. If this evidence is compelling enough, one must take a leap of faith and hope that the effort and cost pays off in some real effect.
Vitamin C is one such product. I have been interested in it for years, based in part on Vitamin C’s well documented systemic importance to collagen stabilization, critical role in wound healing, and its likely role in base excision repair in mutated DNA. Topical Vitamin C possesses some challenges as only the L form is absorbed, and concentrations must be at least 10% to see an effect. Like Vitamin E, Vitamin C is a potent antioxidant that if placed on the skin under sunscreen may provide added protection from all types of oxidative stress including UV light. Some of the most popular products contain both Vitamin C and Vitamin E which act synergistically as Vitamin C can regenerate Vitamin E’s antioxidant properties once used.
Another exciting frontier in skin products are stem cell growth factors. This group, too, lacks the scrutiny of FDA-approved products, but the work of stem cell technology used in other areas of the body make them a compelling area to watch. Stem cells are found in all tissues but the ones that garner the most attention are found in bone marrow and placenta, where stem cells are used directly to repopulate other cells. In the production of cream, we keep stem cells in culture, collect their protein products, concentrate them, and voila, you have a stem cell growth product cream. We know from some studies that as we age, stem cells diminish more with each decade everywhere in the body, including the skin. In theory if we could deliver a high concentration of growth signals to the skin, and as our own stem cells diminish, we might be able to continue providing those critical growth signals. Choose a stem cell growth factor cream that is human, not animal or bacterial, that comes from a highly reputable source and continue to follow reputable sources to learn which ones are deemed the best.
Retinoids are a group of products derived from Vitamin A which have been studied for years and whose benefit on the skin has been confirmed scientifically without question. Tretinoin, also known as retinoid acid or Retin A, is the best-studied and known product in this group. It has been used for over twenty years for diminishing fine wrinkles, lessening skin darkening and generally improving the tone of the skin. Tretinoin is a differentiating factor, which means that it normalizes the way cells develop which over time are altered by aging or oxidative damage. Related molecules to tretinoin are retinaldehyde and retinol, which are not quite as potent as tretinoin but are still effective with a bit less of the downsides of sun sensitivity and dryness. If you are new to this product category, start with one of these less potent molecules, and you can always transition to tretinoin later as your skin becomes used to it. Nighttime is the perfect time to use retinoids.
Q: Some men’s health concerns include broken capillaries, rough skin, acne, aging, and razor burn. What are your tips for treating these?
A: Capillaries are best removed with a laser. However, if the skin appears very red or inflamed it makes sense to start with treating the underlying process before embarking on laser treatment. If you are suffering from minor acne, often over-the-counter options like benzyl peroxide, glycol, or salicylic acid cleansers, and 1% adapalene can solve the problem. Severe acne should be seen by a dermatologist. Rough skin should be treated, especially in mountain areas like Tahoe, by reducing soap usage to only essential areas like the head, under arms, and groin. Follow your shower with an emollient as described earlier to trap water. Razor burn in itself could be an extensive discussion. To diminish the chance of razor burn, shave at the end of your shower when the hair is easier to shave, use shaving gel rather than soap, and apply a non-comedogenic non-alcohol-based moisturizer or toner. To slow aging, wear your sunscreen daily and choose one product to wear each night, either a stem cell growth factor or a gentle non-tretinoin retinoid.
Interested in taking your skin health to the next level? Schedule an appointment with one of Skin Cancer & Dermatology Institute’s medical providers online.