Treating Melasma logo

Dr. Joshua Fox of Advanced Dermatology, PC

Treating Melasma

Tips for a step-by-step approach to prevent and target the issue.

By Dr. Joshua Fox, Advanced Dermatology PC

Melasma is a common skin disorder that affects an estimated six million people in the United States. In fact, 90% of those afflicted are women, according to the American Academy of Dermatology. Melasma is often associated with sun exposure but it’s also common in pregnant women, hence the nickname the “mask of pregnancy.” Other common triggers include estrogen supplements and birth control pills.

The good news for patients is that technologies are evolving to better treat Melasma. The Fraxel laser (a type of fractional laser) is a tool that is increasingly used to treat Melasma, especially in severe cases and in cases where it doesn’t respond to other treatments. The Dual 1550/1927 Fraxel laser received new FDA approval specifically to treat skin pigmentation problems such as Melasma in June 2013. The benefit of the Fraxel laser is that it can safely treat the cells producing pigment yet it protects the outer layer of skin at the same time. Patients who go this route must be vigilant about avoiding the sun and must wear a high grade UVA/UVB sunscreen at all times.

Signs of Melasma

Melasma most often affects young women with so called “olive” or brownish skin tone. The condition is characterized by skin discoloration typically located on areas of the body more exposed to the sun, such as the cheeks, nose, forehead and chin, and to a lesser extent, the neck and arms.

While Melasma does not cause any physical discomfort, managing the psychological stress associated with the appearance can be a challenge. Melasma can rarely fade on its own but most women prefer to treat it because it’s not only unsightly but it also causes some degree of embarrassment. Appropriate treatment can significantly improve quality of life and restore self-confidence.

Tips for Treating Melasma

Fortunately, there are many treatment options to help manage Melasma. Dermatologists are excited about the FDA’s approval of Fraxel for treating Melasma. And while there is no magic bullet for the problem, we have additional therapies at our disposal that are safe and effective. These include:

· The first line of defense is a broad spectrum sunscreen, which will help prevent further skin discoloration. If a patient is vigilant about sunscreen use and stays out of the sun, the condition can spontaneously improve. More importantly, it will help prevent further discoloration.

· One of the first-line treatments is often a hydroquinone (HQ) cream, lotion or gel to lighten skin, which is available over-the-counter and in prescription doses. A dermatologist may also prescribe other topical medicines to lighten skin such as tretinoin (Retin-A), corticosteroids, azelaic acid and kojic acid. Several new products have been developed without HQ to treat the condition.

· Procedures for Melasma include chemical peels, microdermabrasion (a non invasive treatment that exfoliates skin), Fraxel Dual 1550/1927, Q-switched Nd-YAG and Ruby Lasers.

· A final option is a combination of several aforementioned therapies. In one recent study researchers in New York found that microdermabrasion and laser treatments used together can be a safe, a non-invasive approach with minimal or no recovery time, and it had long-lasting effects.

Note the importance of sun avoidance and sunscreen to help prevent Melasma. I recommends everyone apply sunscreen 20 minutes prior to going out in the sun. This is particularly important for people aiming to prevent or minimize Melasma. In addition, reasonable efforts to reduce sun exposure such as wearing a wide-brimmed hat and large sunglasses can also be helpful in avoiding the sun and aiding in the prevention of Melasma.

Advanced Dermatology P.C., Center for Laser and Cosmetic Surgery (New York & New Jersey) provides cutting edge medical, laser & cosmetic dermatology and plastic surgery services. Advanced Dermatology PC

Joshua L. Fox, M.D., F.A.A.D., is the founder and medical director at Advanced Dermatology P.C. He is a leading authority in the field of dermatology with expertise in skin cancer, cosmetic surgery and laser procedures and is program director of a fellowship in laser and cosmetic surgery.

– See more at:

Google Plus

Your 30 Second Heart Check-Up

Your 30 Second Heart Checkup

By: Kasey Panetta

You might want to check yourself out—for your heart’s sake. Coronary disease takes an average of one life every 39 seconds, but your body could be sending you signs that something’s up before it gets to that point. Read on for a couple of things you need to know.

Understand Your Resting Heart Rate (RHR)
RHR is a well-known tool for heart health, and maintaining the same RHR over a long span of time is crucial—a RHR of over more than 70 beats per minute means your heart is working too hard.

A recent study from the American Medical Association showed that people whose RHR changed from less than 70 beats/min to 85 beats/min 10 years later were 90 percent more likely to die from heart disease than those who maintained a steady RHR. If yours increases more than 5 beats/minute over 2 years, talk to your cardiologist about what you can do to lower the number. Here’s how to check your resting heart rate.

Check the Colors of Your Nails
Your nail beds are good indicators of heart health, says Joseph Jorizzo, M.D., professor of dermatology at Wake Forest Baptist Health Center. If they turn black, blue, or red, there could be a problem. Black and blue spots or streaks—called purpura—can indicate circulatory problems and diseases that cause blood thickening. Red nail beds can be a sign of congestive heart disease. If you notice any major change in nail color, make an appointment with your dermatologist, says Joshua Fox, M.D., medical director of Advanced Dermatology.

Look at Your Eyelids
Xanthomas—fatty deposits in the skin caused by high cholesterol—are soft, yellowish, growths usually found on the upper eyelids. (They’re also found on hands, elbows, and knees.) One cause of them can be excess lipids in the blood, which accumulate in skin cells. Those same high blood lipid levels increase your risk of vascular problems and coronary heart disease, leading to heart attack, stroke, and poor blood circulation, says Anne Hamik, M.D., professor at Case Western Reserve University Cardiovascular Research Institute. How? As the amount of lipids in your body increases, they are stored in the cells that line blood vessels. If the cells tear, the lipids are released into the blood stream, blocking passages and leading to a heart attack or stroke. As long as you treat the high cholesterol, the deposits themselves don’t need to be removed unless they’re causing discomfort.

Click here to read at

Upper West Side Office Has Moved

The physicians and staff of Advanced Dermatology, P.C. are pleased and excited to announce that we have moved our Upper West Side Manhattan office to a new expanded facility just a short distance away (same phone number). Our new site offers more luxurious accommodations, more waiting room seating and additional examination and procedure rooms as well as more medical, surgical, cosmetic and laser services. The location has access to the services of Simply Posh Aesthetic Spa which offers a full range of aesthetic services such as facials, and non-invasive fat reduction and skin tightening treatments.

Our new address as of January 27, 2014:
211 Central Park West (Corner of West 81st St & Central Park West)
Suite: 1D
New York, NY 10024
Phone: 212-787-2929 (same phone #)
Fax: 212-787-3077

Transportation Options:
Subway: Uptown B and C Train
Bus: Cross-Town bus stops at our door

You are invited to come visit our beautiful new facility and receive a free skin analysis to identify your skin concerns and to discuss our growing line of medical, surgical, cosmetic and laser treatments with our highly skilled and professional staff. We are offering *$50 off any treatment booked at Simply Posh Aesthetic Spa or *$50 off Botox or microderm-abrasion performed at Advanced Dermatology.

As in the past, we are committed to providing expert diagnosis and treatment for all your medical and cosmetic needs. Our doctors include experts in all facets of Adult, Adolescent and Pediatric Dermatology, Mohs cancer treatment and cosmetic and plastic surgery. We offer the latest laser treatments such as MiraDry, Ulthera, Thermage, ThermiRF, SmartLipo and other non-invasive fat reduction and skin tightening procedures.

We always try to accommodate urgent or emergency cases on the same day and we will continue to offer evening, night and weekend hours for your convenience. You will notice a higher level of customer service with less wait time. We thank you for your continued support and look forward to seeing you at our new site and at Simply Post Aesthetic Spa.

* offers good to April 1, 2014

ThermiRF is now FDA Cleared





Thermi RF is now FDA Cleared!

ThermiRF is now FDA cleared for “thermistor‐regulated energy delivery for both micro-surgical and non-invasive aesthetic applications  for dermatological and general surgical applications in soft tissue and nerves” (see press release attached). This is a huge accomplishment for ThermiAesthetics and is actually a more comprehensive clearance than the original SmartLipo approval.

Click here for the official press release.

Palm Reading: What Your Hands Really Say About Your Health

Palm Reading:What Your Hands Really Say About Your Health


Looking at hands for insight about health is no longer solely the domain of sketchy fortune-tellers. Scientists have found correlations with everything from colored rashes and health conditions like diabetes to white nails and liver problems. A health self-assessment is just an arm’s length away.

Spots and Colors
Occasionally systemic diseases can manifest themselves on hands. Orange or yellow-hued xanthomas, or bumps of lipid deposits on the skin, can signal metabolic conditions like elevated lipids, thyroid disease, kidney problems or diabetes.

Still, dermatologist Dr. Lance Barazani of Advanced Dermatology in Commack cautioned to take self-diagnosis with a grain of salt. “No one should be alarmed if they see something on their hands. Most likely, you are seeing just a rash or irritation.”

Orange palms are often a sign of a large amount of carrots, orange squash or other foods with high levels of beta-carotene, rather than anything more alarming.

Most are familiar with brownish sunspots on the tops of hands, but look out for spots that change shape, color or size, or scab and crust over, which may be pre-cancerous growths. Those with a history of eczema should be aware of their personal triggers, but sometimes eczema can be caused by allergies or irritants in the environment. And some people with recurrent hand eczema often have asthma and hay fever. “Hand eczema is very common,” explained Dr. Barazani. “It’s not typically associated with any other issues or food allergies,” which are common misdiagnoses. Avoiding harsh chemicals and cleaners can help keep the irritations down.

Blood blisters are patches of blood pooled under the skin and are caused by friction trauma to the surface. Repetitive movements like the kind in manual labor, exercises that excessively rub palms against equipment (like tennis) or hobbies like drumming can all cause the blisters. Don’t pierce it! Apply ice, clean and dress the area and beware of any that reoccur or don’t seem to heal. Sometimes malignant melanomas can look like a blood blister under the nail.

Shapes on the hands and fingers can also be diagnosed. Lumps, or nodules, under the skin on the knuckles can be a marker for osteoarthritis, gout or rheumatoid arthritis. Reddish-colored bumps on knuckles or fingers can occasionally be a sign of an internal malignancy. And recurrent pink spots and broken capillaries on cuticles is a hallmark of dermatomyositis, a condition that affects connective tissue.

“You should always watch anything that doesn’t go away or keeps coming back,” said Dr. Barazani. Even benign hand nuisances like warts should be treated. In fact, warts are really a sign of infection with a strain of human papillomavirus (HPV) and they are contagious. Use an over-the-counter wart treatment and if that doesn’t work, a dermatologist can freeze them off before they spread.

Nail Nuisances
There are plenty of popular myths about the meaning of marks on nails, like white spots indicating calcium deficiency, but usually changes in the nails have to do with trauma or injury. White spots mean that something has damaged the nail, and as it grows out, it displays that tell-tale whiteness. Even an overly-enthusiastic manicure or an allergic reaction to nail polish can cause this kind of stress to the nail. Extremely white nails can indicate an issue with the liver, but other bodily symptoms would most likely be present.

Cracked cuticles are another bothersome hand nag and are caused by dry and cold weather. Nails prone to cracking should be covered in gloves, moisturized or pampered with cuticle creams to keep the area from being exposed to the dry winter air. Try not to pick at any loose ends and instead trim with a cuticle scissor as necessary. Most likely the environment is the culprit, but sometimes a bad diet can contribute to less-than-stellar skin around the nails. Make sure you are getting enough zinc and essential fatty acids, along with plenty of water to drink.

The hand health takeaway lesson is a golden one: Keep a close watch on anything out of the ordinary. Concerns about pain or unusual symptoms should prompt a visit to an internist or primary care physician.

Fascinating Finger Lengths
Recent studies have demonstrated that the length of the ring finger, in comparison to the index finger, is influenced by how much testosterone a baby was exposed to in the womb, which is associated with an increased or decreased risk of certain diseases. The more testosterone in utero, the longer the ring finger. Women with longer index fingers are thought to have received more estrogen in the womb and are more likely to develop breast cancer in their lifetimes. For men, those with longer index fingers were 33 percent less likely to get prostate cancer, according to a 2010 study published in the British Journal of Cancer.