Archive for Skin Care

Hot Topic in Dermatology … Introducing our new “superscreens”

Hot Topic in Dermatology … Introducing our new “superscreens”

Skin aging can be divided into two categories, intrinsic and extrinsic aging. Intrinsic aging is determined genetically and reflects the naturally occurring process that occurs with chronological age. There is not much that we can do as your cosmetic providers to combat this type of inevitable aging. Extrinsic aging on the other hand is the result of several interactions with environmental factors, most importantly being the SUN. “Photoaging” is a popular term that was coined in the 80’s to describe the negative effects that chronic UV exposure have on the skin. With UV exposure we see changes in the skin such as dry rough texture along with skin laxity, pigment changes, redness, visible blood vessels, deep creases and wrinkles.

Traditionally studies have shown the negative effects that UVA and UVB play in the role of aging skin as well as the potential for skin cancer. As sunscreens have evolved, we now notice that many will say broad spectrum meaning that they protect against UVA and UVB damage. What we have failed to consider until recently is the effects that other wavelengths of light can contribute. There is a growing body of knowledge that now recognizes the damaging effects caused by infrared (IR) and visible light. Solar IR is the actual heat that you feel from the sun. When skin temperatures are raised for a long period of time we see similar changes in the skin that are associated with photoaging. Therefore contributing to the ideas that thermal-aging or premature aging can be induced by heat causing destruction of collagen in elastin. So now that we have all this new information … what next?

A new category of sunprotection is now beginning to evolve … “superscreens”! Companies are now looking for a new approach to sunscreens with the most comprehensive protection and active ingredients. We are so excited at USF Health Cosmetic and Laser Center to carry the latest in sun protection with SkinMedica’s® Total Defense + Repair and Colorescience’s® Even-Up. These products not only contain the best UVA/UVB protection but they also contain specialty antioxidant blends to provide protection against IR. They not only protect but Total Defense + Repair minimizes inflammation and promotes the skin’s ability to restore itself. There are options for tinted or non-tinted depending on your preference. Don’t hesitate, come see us today and let us help you provide your skin with the ultimate sun protection from the experts here at the USF Health Cosmetic and Laser Center.


Nicole Hogue, ARNP, Cosmetic Practitioner at USF Health Cosmetic and Laser

SkinMedica Total Defense and Repair Superscreen

SkinMedica Total Defense and Repair Superscreen


Hello From USF Health Cosmetic and Laser Center

Hello From USF Health Cosmetic and Laser Center

Click the video link below and learn about what the USF HEalth Cosmetic and Laser Center had to offer.

Click Video Link USF Health Cosmetic and Laser Center Services

Neil Alan Fenske, MD, Professor and Chair, Medical Director Nicole Hogue, ARNP-C, Cosmetic Practitioner Erika Dare, ARNP-C, Dermatology and Cosmetic Practitioner

(Center) Neil Alan Fenske, MD, Professor and Chair, Medical Director
(Left) Nicole Hogue, ARNP-C, Cosmetic Practitioner
(Right) Erika Dare, ARNP-C, Dermatology and Cosmetic Practitioner

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Rejuvenation Prejuvenation

Obagi 360 Demonstration

Rejuvenation PreJuventaion

Often patients come to our office seeking skin REjuvenation. These are male and female patients alike, typically in their 40-50’s that have been exposed to the Florida sun for a number of years and some even may be guilty of the ‘ol baby oil and iodine trick in order to get a suntan. We know that at about age 40 several ageing phenomena start to take place in the face. It is common to start to see “bags” under the eyes as the eye socket begins to recede making us look “sunken”. Additionally, wrinkles of motion start to appear at rest from being overused for several decades and actually become little etched in scars. There is a shift that takes place of our facial fat pads that can often exaggerate the lines around the nose and mouth creating a void or loss of volume. You may be starting to think to yourself that this is painting quite a grim picture. With a competitive job market and the baby boomers coming of age we see an influx of patients inquiring about cosmetic procedures.

It is interesting to note that the American Society of Plastic Surgeon Statistics show that injectables like dermal filler for instance has increased steadily anywhere from 5-10% yearly and continues to trend even higher.  What is even more interesting to note is the new group of patients that are coming to our offices seeking what we like to call “pre-juvenation”. These are young women and men in their 20-30’s that can see into the future by looking at their parents and quite frankly may not like what they see. These patients come seeking interventions that they can do to prevent the signs of aging hence we call it “pre-juvenation”.

There are several procedures that are appropriate for the younger generation that wish to be more proactive in their skin’s appearance that was not available to generations before them. Immediately one very popular cosmetic treatment comes to mind, the use of neuromodulators such as Botox, Xeomin, and Dysport. We often hear in the office from a 50 year old patient, “I am not old enough for Botox”. In reality, neuromodulators such as Botox are actually preventative in nature. Understanding the science behind these injectables is crucial to knowing their role in preventing the aging face. This is a product injected into a muscle that is responsible for making a wrinkle. Days after the injection this muscle becomes weaker and unable to make the expression responsible for giving us a wrinkle!  Starting an intervention such as Botox early will literately hault the progression of aging. Most commonly patients are injecting in between the brows for the scowl lines and around the eyes in the area we refer to as the crow’s feet. Studies involving identical twins, one using Botox and one not for over 10 years yield remarkable results that attest to pre-juvenation.

Obagi 360

Obagi 360

So what else can patients do in the “pre-juvenation” realm? We always recommend starting on a good topical skincare regiment that includes active ingredient products such as retinols, antioxidants, moisturizers and of course a broad spectrum physical sunblock. Retinols slow the age related loss of important skin components while boosting collagen. Antioxidants slow down and prevent the effect of free radicals from the inside out. Other popular interventions that are appropriate for this age group are non-ablative laser and radiofrequency treatments that stimulate collagen with hopes to replenish collagen before it starts to steadily degrade. Chemical peels are also a great way to stay ahead and keep your skin looking youthful and radiant.

Waiting to see a wrinkle develop will put you behind the game in terms of aging. As the vast body of knowledge in cosmetic dermatology continues to grow we certainly see a trend of starting early. Even though we are speaking about patients in their 20-30’s it is never too late to start to pre-juvenate.

Always trust your skin to the experts, come see us at the USF Health Cosmetic and Laser Center to start your pre-juvenation today … after all it is where beautiful skin happens.

By: Nicole Hogue, ARNP-C

Nicole 1

Nicole Hogue, ARNP, Cosmetic PractitionNicole Hogue, ARNP-C

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The Mask of Melasma, Brown Discoloration on the Face

Brown discoloration on the face.  A mask that never leaves.  It’s the reason you slather on sunscreen and hide out under a hat.  Melasma is a common skin condition found in many females and a small percentage of males.  Its presence is characterized by brown and tan patches that occur on many parts of the face.   It is thought that melasma occurs when the cells responsible for making color in our skin (melanocytes) become hyperactive and produce an abnormally high level of skin color (melanin). Melasma is most often seen in darker skin types such as Latinos, Asians, African Americans, and Indians.  Many times you may hear it referred to as the ‘mask of pregnancy.’ Although we typically do see melasma occur in pregnant women, we also find that it may sometimes be inherited, or as a side effect of hormone or oral contraceptive use.

Finding the exact trigger for melasma may be difficult to pinpoint. The condition’s unpredictable nature makes it hard to prevent; however, there are ways to treat and blend melasma into the surrounding skin.  The depth of the melasma in the skin can sometimes dictate which treatments will be most beneficial and how stubborn it may be to respond.  The first step in melasma treatment typically consists of a topical regimen aimed at blocking melanocytes from the process of producing extra color in the skin.  A regimen for melasma may consist of hydroquinone and/or non-hydroquinone blending products, retinols, and sometimes gentle low strength topical steroids.  Hydroquinone based products such as Obagi’s Clear® and Blender® work to block an enzyme responsible for allowing melanin to be produced.  A non-hydroquinone product such as SkinMedica’s Lytera® works by blocking all four pathways of melanin production through the combination of antioxidants and natural ingredients such as licorice root.  These creams and lotions help to prevent the production of new melasma in the skin. Topical retinols are also important to help increase cellular turnover on the skin’s surface.  This allows for the pigment already present in the top layer of the skin to be sloughed off at a faster than normal rate.  In addition to the topical regimen, your provider may suggest exfoliating washes such as Obagi’s Exfoderm® or SkinMedica’s AHA/BHA Exfoliating Cleanser®.  Retinol and exfoliation use also allows for hydroquinone and steroid products to penetrate deeper and more efficiently into the skin.

Melasma Pre treatment

Melasma Pre treatment

Melasma Post treatment

Melasma Post treatment


Many services may be combined with topical treatments for melasma. Chemical peels work similarly to retinols and can help to decrease the amount of time it takes to remove pigment present on the skin surface.  Sometimes a laser may be employed to treat melasma as well.  Q-Switched Alexandrite lasers may be used to target brown discoloration in the skin.  These lasers may help to break apart the pigment and allow it to be reabsorbed. Intense pulsed light, or IPL, is sometimes used by practitioners as a modality to treat melasma.  Unfortunately, not all lasers work for melasma.  While it may temporarily decrease the discoloration, melasma has been known to sometimes recur after laser or light has been performed.

The key to keeping your melasma away after an intensive treatment program, is to slather on that sunscreen and wear your hat! Sun exposure has been known to deepen the color of the melasma and can sometimes make the condition worse.  In addition, discontinuing or changing hormones or oral contraceptives (with your doctor’s permission of course) may help control melasma.

It is most important for a patient with melasma to consult with a provider in order to discuss treatment options most suitable for their condition.  If melasma is a concern for you, stop by the USF Cosmetic & Laser Center, and allow us to develop a personalized treatment plan for you!

By: Erika Dare, ARNP-C Dermatology and Cosmetic Practioner, USF Health Department of Dermatology and Cutaneous Surgery, USF Health Cosmetic and Laser Center

Erika Dare, ARNP-C

Erika Dare, ARNP-C

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Sunscreens prevent skin cancer. Some epidemiologic data suggest low levels of vitamin D may increase susceptibility to internal cancer as well as infection, hypertension and autoimmune disorders. Since the sun stimulates production of vitamin D precursors in the skin while sunscreens reduce production it is speculated some of us could be vitamin D deficient and thus at risk for these disorders. Are you now thinking of tossing out your sunscreens and going to the beach or purchasing a package of tanning parlor visits? Hold on! This confusion is a classic example of a “little knowledge is a dangerous thing”.

We have known for many years that sunscreens prevent sunburn and skin cancer by blocking the UVB rays that vary in intensity throughout the year. We now know that longer, more deeply penetrating UVA rays which account for more the 90% of UV light and stay relatively constant throughout the year also play a role in skin cancer as well as skin wrinkling. This is why dermatologists now recommend the newer generation of “broad spectrum” sunscreens that block both groups of rays. SPF rates the amount of UVB protection and the FDA will soon be releasing a new 4-star UVA rating system to quantity the amount of UVA protection. For day to day use (unless you work out of doors or plan recreational sun exposure) a SPF 15 is more than sufficient for most of us. Unfortunately, some commit “sunscreen abuse”, meaning they now go out much longer than before with the false expectation they are getting no sun damage. They may rationalize that by increasing to a SPF 30 they have doubled their protection. Not so fast! A SPF 15 sunscreen blocks 93% of UVB rays, while a SPF 30 blocks 97%–not much additional protection for the increased cost and irritancy!

A few years ago, some studies disclosed a relationship between internal cancer (esp. colorectal cancer) and vitamin D deficiency. In other words, vitamin D perhaps served a “protective” role and since suncreens and/or strict sun avoidance  reduced vitamin D production it was speculated by some and politicized by others as a rational to abandon photoprotection altogether. Making matters worse, some suggested that the vast majority of Americans were vitamin D deficient, while others stated the daily recommendation for vitamin D was too low. Some are now promoting increased sunbathing and utilization of tanning salons, despite the mounting evidence that UVA (the light rays emitted by tanning salons) causes skin cancer, in particular, melanoma and premature aging.

Many subsequent studies assessing the role of vitamin D in “protecting” against internal cancer have conflicting results and it will take many years with long-term prospective studies to know for sure. As well, there is controversy regarding the extent, if any, of significant vitamin D deficiency in Americans. Nonetheless, you can obtain vitamin D from diet (e.g. salmon, fortified milk and orange juice) without subjecting yourself to the risk of sun exposure. The National Institutes of Health claims it doesn’t take much sunlight to make adequate vitamin D-likely as little as 30 minutes twice a week without sunscreen!. Alternatively, simply taking supplemental vitamin D (1,000 IU) if you have had skin cancer, are at risk for skin cancer, or simply want to avoid the unsightly wrinkling and discoloration caused by habitual sun exposure is a much safer way to assure adequate levels. My closing recommendation is moderation and see your dermatologist annually!

Article written by: Neil Alan Fenske, MD, Professor and Chairman of the Department of Dermatology and Cutaneous Surgery at USF Health            


Cosmetics and Lasers for Skin of Color

Cosmetics and lasers for skin of color

Open up a cosmetic online forum or an aesthetic magazine and you are bound to read horror stories which recount laser treatments gone wrong on those with skin of color.  Unfortunately, when laser is placed in the hands of poorly trained individuals or an inappropriate device is used, adverse reactions can occur in darker skin types.  The truth is that people who have an olive complexion or even darker skin color can still have a good majority of the laser treatments available to lighter skinned individuals; however, the provider must use the appropriate device for their skin type.  At USF Health Cosmetic & Laser Center, we use 1064 wavelength lasers to treat our patients with darker complexions.  Using this type of device and customized, conservative energy settings, we can treat target lesions such as hair or texture with a much lower risk of causing severe burns or hypo/hyperpigmentation.  With a 1064 wavelength device, we enable our laser to focus on the target and less on the pigment in darker skin. While no procedure is 100% without risk, a conservative approach with the right tools and consistent follow up is the most effective way to prevent complications.

Another common misunderstanding we hear in patients with skin of color is that they have been told there are very few cosmetic treatments appropriate for their skin type. While some treatments may remain off limits, there is still a plethora of cosmetic goodies and procedures that can be used on darker complexions.  In addition to cosmetic procedures, we offer customized skin care plans and products safe for use on skin of color.  At USF Health Cosmetic & Laser Center we can help darker skin types with issues such as:

  • Botox
  • Dermal fillers
  • Post inflammatory hyperpigmentation
  • Skin Care
  • Melasma
  • Active acne
  • Acne scarring
  • Oily skin
  • Texture
  • Nail fungus
  • Skin tightening
  • Tattoo removal
  • Hair removal

If you have a darker skin complexion and cosmetic concerns, stop by or call to set up a consultation.  It is important to meet with one of our providers to further assess your skin’s needs and develop a comprehensive plan tailored to your specific skin type.

by:Erika Dare, ARNP-C, cosmetic/dermatology practitioner at USF Health Cosmetic and Laser Center


Sunless Tanners


Sunless Tanners

Get the Skinny on Sunless Tanners

Long gone are the days of slathering baby oil and iodine on your skin and baking in the sunshine like a chicken on a kebab.  Even though being pale was once considered a sign of health and beauty, present day media now perceives ‘the tan’ as in vogue.  Unfortunately, what the media and the general public do not understand is that tanning is evidence of skin damage.   Melanin is a pigment which lies in the skin and is responsible for the brown color of your tan.  Melanin production increases with sun exposure and dissipates UV radiation as a means to protect you from skin cancer formation.  With age, the amount of melanin decreases and this shift can leave you with more and more burns.

Fake Bake

Through the years, research has supported evidence that the sun’s rays contribute to skin cancers and premature aging.  More recently, you may have heard about sunscreen regulation changes and the importance of broad spectrum products.  With the growing body of knowledge we have regarding the purpose of melanin and the harmful effects of UVA and UVB rays, the general consensus of most dermatologists is to take a rain check on roasting in the sun.

So how can you get a bronzed glow without the risk of skin cancers?

We certainly do not condone tanning beds (aka cancer in a box), but we do support the use of many other products available over the counter.  Many people use cosmetic bronzers or spray tans.  Others prefer sunless tanners which work with the body’s natural processes to develop a tan.

How do sunless tanners work?

Sunless tanners contain a chemical called dihydroxyacetone (DHA).  DHA is a safe and nontoxic chemical that was once used as a sugar substitute but was accidentally found to have tanning properties. When DHA is applied to the skin, a chemical reaction occurs with proteins in which the end result is a chromophore known as melanoidin- this will give a brown color. The chemical reaction process known as the Maillard reaction typically takes a few hours and results in darkening of the skin.  Luckily, the Maillard reaction is only seen in the most superficial layer of the skin, and therefore, the ‘tan’ can be easily removed with exfoliation or allowed to fade over days.

What do I need to know about sunless tanners and their application?

Sunless tanners are a safe and effective way to achieve a sun kissed look without the price of skin cancer.  They are easy to apply with the use of gloves, and many are combined with a dye so that areas where the tanner has been applied can be seen.  When applying sunless tanner, be sure to rub less onto areas with thicker skin such as the knees or elbows.  Since DHA is absorbed into the superficial layers, these thicker areas will absorb more DHA and cause darker pigmentation.  Most importantly, sunless tanners will NOT protect you from the sun like natural tans from melanin do.  So be sure to still apply your broad spectrum sunscreen every time you are in the sun!

Does the USF Health Cosmetic & Laser Center carry any sunless tanners?

Yes we do! We carry Fake Bake® in our office.  It comes with a handy application glove and is a favorite amongst our staff! Come by our office and pick up a bottle to try for yourself!

By: Erika Dare, ARNP-C, Dermatology and Cosmetic Practitioner at the USF Health Cosmetic and Laser Center on Davis Islands

Erika Dare, ARNP-C

Erika Dare, ARNP-C


American Academy of Dermatology. (2010). Prepping for fall dances shouldn’t increase skin cancer risk. Retrieved from

Z.D., Draelos. (2013). Sunless tanning: An alternative to sun exposure. Best Practices in Cosmetic Dermatology, 0(2), 10-11. Retrieved from


The Winter Itch of Dry Skin

The winter itch  of dry skin.

Winter weather comes with dry, itchy skin that may start to crack and possibly become painful. Several factors contribute to dry compromised skin including but not limited to cold weather, low humidity, overuse of soap, and genetics. Some of these factors we can control and others we cannot control, like genetics. However, there are things we can do, avoid, and apply to aid in minimizing dry itchy skin.

#1 Drink Plenty of Water. Drink at least 8 glasses of water a day to stay hydrated to keep your skin soft and less dehydrated from the environmental changes.

#2 Use a Small Amount of a Gentle Soap. Use a gentle soap with minimal ingredients and a small amount. The more soap you use and the more ingredients the soap has the drier you are more likely to be. Very dry people may consider only using soap on the really dirty or stinky parts. Our office recommends for the face SkinMedica® Sensitive Skin Cleanser and for the body Cetaphil® Skin Restoring Body Wash.

#3 Avoid Long Hot Showers or Baths. The hotter the water and the longer you are exposed the more dry your skin will become.

#4 Use a Moisturizer. After bathing pat dry with a towel and while your skin is still moist apply a moisturizer. Our office recommends a facial moisturizer specifically tailored for your skin type. And for those with really dry compromised skin we suggest a moisturizer that contains ceramides and other lipids to aid in restoring and protecting the skin barrier. We recommend SkinMedica® TNS Ceramide Cream for the face and Ceratopic Replenishing Cream for the body.  For really dry, red, painful cracked skin one should use a healing ointment, such as SkinMedica® Restorative Ointment.  

#5 Wear Gloves and other Protective Clothing. Wearing gloves and other protective clothing protects your skin from the environmental conditions that cause compromised skin. When washing dishes, preparing food or cleaning bathrooms we recommend you keep your hands as dry as possible. One technique you can use is the double glove technique. First, put on thin cotton gloves and then put rubber gloves over the cotton gloves. Also, wear hats, gloves, jackets, etc to protect your skin when going outside during the cold months.

#6 Hand Washing and Antibacterial Gels. Washing your hands is a must. Just make sure that you thoroughly and completely dry your hands and then immediately apply a moisturizer to help lock in the moisture from washing your hands. If this is not feasible consider using a barrier type moisturizer. Remember lotions in soaps do not moisturize, they rinse away like the soap. Also, antibacterial gels are good at getting rid of bacteria, but they have a very high percentage of alcohol that tends to dry the skin.

If you continue to have winter itch and dry compromised skin after trying the suggestions above see the dermatologist for more intensive treatment and detailed education for your unique skin.

Dr. Neil Alan Fenske, MD

Neil Alan Fenkse, MD is the Professor and Chairman, University of South Florida Morsani College of Medicine.

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