JUNE FEATURES

Highlights from DermFoot 2018 from Seminar Co-Chair: Annette Joyce, DPM

DermFoot Faculty Expert Article:
Peel Back the Winter Skin from
Christy Bennett, DO

Video Tutorial with G. Dock Dockery:
O to Z Procedure

Changing the Way Podiatrists See Lower Extremity Dermatology with Dermoscopy
Highlights from DermFoot 2018:
A Groundbreaking Year
Annette Joyce DPM, Co-Chair

As I look back at the path of DermFoot over the past three years, I can begin to see the difference our program is making in the lives of our attendees and their patients. One of our physicians texted me a question last week, “Is it bad for the pigment to be in the ridges of a melanocytic lesion?” followed with an enthusiastic “ I found 2 melanomas already!” This is the “buzz” of excitement we generate each and every year after DermFoot concludes. Practical knowledge that translates into clinical success. The skin is where it all begins.
 
Our journey this year began at the Inner Harbor in April with some of the brightest stars in podiatry and dermatology today. A regenerative medicine track featuring David Armstrong DPM and Pat Agnew DPM offered highlights on wound care, allografts, and sports medicine in this growing field of scientific research. General dermatology tracks taught by Anna Yasmine Kirkorian MD showed us the most common pediatric rashes and eruptions in young skin while Beth McLellan MD shared her expertise in chemotherapy and oncology in the aging population.
 
Ash Marghoob, a legend in dermoscopy education, provided a full, 2-hour track on dorsal skin lesions. Brad Bakotic DPM, DO brought the audience to an emotional standstill with his keynote speech, “We preach parity, yet we still do not fully practice it. As lower extremity specialists, we have to OWN the skin. Our future is very bright in this field.”
 
Scientific Chair, Dr. Joel Morse brought us a much needed break from hours of quiet lecture time with his passionate and sometimes heated game of dermatology jeopardy, known as “DermFanatics”. Multiple choice case study questions were presented using our new “DERMfoot 2018” App, and textbooks were awarded to the winners.
 
A Council for Nail Disorders superstar, Nat Jellinek MD, taught his expert surgical skills on evaluating and managing longitudinal melanonychia and erythronychia. Dr. Jellinek’s algorithm for the shave and punch matrix biopsy left the audience enthralled and asking for more next year.
 
Warren Joseph DPM, moderator and presenter, summarized this year’s meeting with, “These are the conferences that can really change lives”. As DermFoot 2018 concludes another monumental year, let me offer our sincerest gratitude to all of the sponsors, attendees, and faculty who contributed to the success and momentum of DermFoot.
 
Please mark your calendars for April 11-14, 2019 and join us in Tyson’s Corner VA for the next DERMfoot conference. Early bird registration is now open at www.dermfoot.com
What Our Attendees Are Saying About
The DermFoot Difference
June 2018 Expert Article
From Your DermFoot Faculty
Peel Back the Winter Skin
Christy Bennett, DO

With summer looming soon in areas where the weather takes a hit from Old Man Winter, people are eager to show their legs and feet. In areas where it is warm year long, an interest in “showing skin” is always front and center. Many Podiatrists are incorporating healthy and safety-paramount pedicures into their practices. We can go a step further and offer our clients soft and fresh skin for the look and feel that they crave. Chemical Peels are a popular way to remove layers of dead skin—Stratum corneum and encourage the deeper layers to turnover and improve collagen and elastin formation. Chemical peels were used in Cleopatra’s time when she bathed in sour milk to make her skin soft. Today, we know that the chemical she used was Lactic Acid—an Alpha Hydroxy Acid.
For facial skin, there are several safe and even deeper chemical peels which can be performed to reduce wrinkles and soften the skin. When these peels are performed, layers of dead skin may visibly shed—comparable to the peeling seen after a sunburn. With chemical peels on the lower extremities, the turnover of the skin increases; however, the sheet-like shedding is unlikely. Regardless, the skin becomes softer and smoother. 

Deeper peels are contraindicated on the lower extremities due to higher risk of adverse events because this skin takes longer to heal, and the sebum-producing glands are much lower in concentration.
Typically, the skin is categorized based on it’s reaction to sun exposure. A rating scale by Dr. Thomas Fitzpatrick groups fair and light skin up to darkly-pigmented brown skin. The lighter skin tolerates stronger acids and the darker skin reacts with more adverse effects thereby requiring weaker acids. There are several chemical options for peeling of the skin. The most commonly used acids are Alpha Hydroxy Acid (AHA).  Peels are further divided into the level of the skin that the peeling agent descends. These layers are superficial, medium and deep. Some peels can bridge groups depending on how many coats of the chemical are applied. Those pertinent to superficial peeling are AHA’s like Glycolic Acid from sugar cane, Lactic acid, Citric acids from fruits and Malic acid from apples. Beta Hydroxy Acids (BHA) like Salicylic acid from willow bark are popular and effective but contraindicated in allergies to aspirin. We need to ask if the “allergy” is gastrointestinal irritation or a true allergy or anaphylaxis. 

Trichloroacetic acid is an analogue to vinegar and it can go deeper into the skin layers if the percentage in the peel is higher. Retinoic acid—familiar because of Retin A™. This is a Vitamin A-derived product and present in many OTC lotions to improve skin texture. It plays a key role in turnover in skin cells and studies show that it may prevent and cause regression in actinic keratoses and non-melanoma skin cancers. 1,2   

What is the best way to begin offering Chemical Peels? Learning the basics is key. Most commercial companies that produce peels for professional use will offer education on the acids, client selection and rejection and the procedure itself. A Podiatrist should start with a body peel because it is safe for non-facial skin and designed with a combination of acids to offer the best properties of each one. These will usually come in kits with all the chemicals needed. Body peels will be very superficial to superficial. They will go no further than the Stratum basalis and are typically safe in all six of the Fitzpatrick skin groups from very light to dark skin.  This means you only need one product. While many brands are available, two examples of these body-designed peels are PCA Smoothing Body Peel and Stacked Skincare TCA Multi-Acid Body Peel. Once a practitioner has full knowledge and an increasing comfort level with the individual acids and strengths appropriate for the area, a non-commercial blend may be considered. What about the current YouTube rage of the Baby Foot™?  The acids in this are Glycolic, Lactic, Citric and Salicylic acids. It should be reserved for the feet only.

One key piece of information to emphasize to your patients is that after a peel, sunscreen is not optional. The freshly-denuded skin will be much more susceptible to UVA and UVB rays. SPF above 30 is preferred. Your clients will be ready for summer clothes and flip flops.

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  1. Skin Cancer Prevention Strategies: Tried, True and New. RL Moy, S. Famini. Skin Cancer Foundation.
  2. Retinoids for prevention and treatment of AK’s. Ianez, et al. An Bras Dermatol. 2013, 88 (4):585-593
  3. 3.      Diagrams: Edited/iStockphoto-ttsz. Used with permission.
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DermFoot Faculty Member: G. Dock Dockery

Performing an "O to Z Procedure"
Dermoscopy and Podiatric Dermatology
Changing the Way We See Our Patients

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