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Dermatologist Jennifer Goldwasser Gives The Skinny on Skin

GoldwasserSought after Dermatologist Dr. Jennifer Goldwasser is back in town. She is now seeing both children and adults at her new offices on Central Park Avenue in Hartsdale. We asked her a few questions about skin, sun exposure, diet, aging and more – and here is what she shared:

Tell us about yourself. where did you train, where do you practice and what are your areas of specialization?

My undergraduate training was in nutrition at Cornell, which is a little unusual for a physician. For medical school I went to Downstate in Brooklyn. I interned at the New York Hospital-Cornell Medical Center and went back to Downstate for my dermatology residency. I have been caring for adults and children with diseases of the skin, hair and nails for the past 25 years in lower Westchester.

What are some of the most common reasons your patients schedule visits?

I commonly treat patients with skin cancer, psoriasis, acne, eczema, rosacea, skin infections, hair loss, and nail disorders.

What skin problems do you see that are preventable if patients are more vigilant?

Skin cancers and pre-cancers are highly preventable since most of them are caused by overexposure to the sun. Smoking also contributes to skin cancer. Lifestyle plays an important role in many skin diseases. Rosacea patients often benefit from alcohol avoidance, and psoriasis patients may see improvements with weight loss, smoking cessation, and alcohol avoidance. Patients with a tendency toward eczema need to be careful to avoid common irritants to the skin, like wool, perfumed and harsh soaps, and excessive sweat.

For teens, are there any new treatments for acne?

There are some new acne treatments! Topical minocycline (Amzeeq) recently became available. some excellent topical retinoids are now available over the counter. Neutrogena is offering a red and blue light acne mask, which can be helpful. More and more information is available about diet and acne--probiotics can even play a role in acne treatment.

On the other end of the spectrum, what can you do to help patients with age spots?

There are many different types of "age spots": Sun spots (lentigines), liver spots (seborrheic keratoses), skin tags and red spots called cherry angiomata are all different forms of age spots. These can generally be destroyed easily by freezing them, burning them, or cutting them off.

What are the most frequent signs of sun damage that you see? Has this gotten more prevalent in the years that you have practiced?

Sun damage manifests in many different ways. Some people develop wrinkles, some people have alterations in skin pigmentation or "mottling", and some people notice that their skin is thinner and more fragile. Suntanning gained in popularity in the 1950's, so many baby boomers are especially likely to have been overexposed to the sun in their youth. Tanning parlors proliferated in the 80's and 90's, and that took a toll, too. By the time i started my dermatology practice in 1994, we were already starting to see the effects of these practices. Fortunately smoking is much less common now, and that has helped somewhat.

What’s your view on Botox and other cosmetic skin treatments?

I'm not a cosmetic dermatologist, but injectable anti-aging treatments like Botox and fillers are popular. I tend to encourage a healthy lifestyle over these interventions. Eating a healthful diet, good sleep hygiene, regular exercise, avoiding sun/tobacco/alcohol, and maintaining a healthy body weight are the best bets for maintaining a youthful appearance, and good health, in my book.

How can you help patients who are experiencing hair loss?

Hair loss can occur for many reasons, but the most common type of hair loss that i see is androgenetic alopecia. This is an inherited type of gradual hair thinning. Most people recognize this type of hair loss in men because the pattern is so characteristic, but in women, the process is more subtle, starts a little later in life, and can pick up speed at menopause. Fortunately, there are many approaches to this problem: topical medications, light treatments, camouflage techniques, and hair transplants, to name a few. It's important to take a complete history, do a thorough exam and appropriate lab work, and discuss all the available options, because hair loss is an emotionally fraught diagnosis, especially in women and young men.

How does diet affect your skin?

Since my background and interest are in nutrition, I have so much to say on this topic, I don't think I could begin to address all the answers to that question in a column. Suffice it to say that I advocate a whole foods/plant-based diet. I like the simple way Michael Pollan puts it: "Eat real food (not too much), mostly plants". I spend a great deal of time interviewing acne and rosacea patients about dietary habits. Often these conditions are more of a "subtraction problem" than they are an "addition problem". Sometimes, what we need to address is what to eliminate or reduce, rather than what prescription to write. I counsel my acne patients to avoid cow's milk, whey protein, and foods with a high glycemic index like white starches, sugary drinks, and sweets. I ask all my rosacea patients to consider eliminating or reducing alcohol, especially red wine.

Have you ever seen skin conditions that you are unable to diagnose? Do you ever get stumped?

Of course I've seen skin conditions that have stumped me, but there are many ways to approach a diagnostic challenge. I believe in the power of slow medicine: taking the time to elicit a complete history and to expose and examine the patient completely can go a long way to solving mysteries. It can also be helpful to know your patients over time--continuity of care is a powerful tool!

I can think of an example: I saw a young man who happened to be an identical twin. Neither twin had experienced significant acne during the teenage years, but this young man suddenly developed severe cystic acne in his twenties. I couldn't imagine why this was happening out of the blue, but i suspected there must be some outside force at work. Sure enough, when I delved, it turned out the patient had been given an IV agent for an imaging study, and that triggered his terrible acne flare. If I didn't know him and his identical twin brother over the years, or if I didn't dig deeply into his recent history, I might never have figured out the cause of his issue.

Fortunately, skin is accessible to biopsy easily, and I work with some incredible dermatopathologists who can offer invaluable assistance. Finally, there is no shame in enlisting the help of other clinicians--sometimes it takes a village! Electronic medical records make it a bit easier to share information with other physicians, which can really create some synergy in difficult cases, and I try to leverage that. Of course, it also helps to have a solid relationship with the patient--physician-patient "teamwork" can make all the difference in tough cases.

Schedule your appointment with Dr. Jennifer Goldwasser at 210 N. Central Avenue, Suite 320 in Hartsdale by calling 914-422-3376 and learn more at her website at Goldwasserderm.com.

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