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Scott Webb: Some skin conditions are temporary and will go away on their own. But others like eczema, acne, and rosacea may require the expertise of a physician like my guests today. I'm joined by Dr. Daniel Heckman. He's a board-certified family physician with a special interest in treating dermatological conditions and performing skin procedures. And I've got many questions for him, including some questions about skin cancer. So I hope he's ready.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, thanks So much for your time today. We're going to talk about the common skin conditions that many of us experience when we're younger and then as we age through the years. And it's so great to have your expertise today. We'll start here. What is eczema and what causes it?

Dr. Daniel Hekman: So eczema essentially is just a broad term for dermatitis or inflammation of the skin. And you can think about this in a way of what would cause this inflammation of the skin. Usually, it is due to a decreased barrier function of the skin. So it makes it more leaky where water can then evaporate out that leads to dryness, which leads to irritation, which leads to itching and itching triggers that whole inflammatory cascade of redness and thickening of the skin, and it can even get infected.

Scott Webb: Yeah. And So in my experiences over the years, I've folks with eczema on their elbows, on their knees. Is that the only places folks get eczema or can it be other places as well?

Dr. Daniel Hekman: So it depends on what age the person is. So this is classically a condition of childhood. And it does actually affect like 5% to 20% of children worldwide. And that's where you'll see it in the flexural surfaces. We call it the antecubital fossa or the area that's on the front side of your elbows, on the backside of your knees. And then, For whatever reason into adulthood, it does change over to the kneecaps and the elbows themselves.

Scott Webb: Yeah, that's been my experience. And I've always wondered, is it just itchy? Is it also painful and are folks making it worse by scratching?

Dr. Daniel Hekman: It is itchy. If it gets infected, it can become painful. And yeah, as I did mention, so if you are scratching this, it's actually an injury to your skin and that calls in more inflammatory cells that then propagate the itching and it becomes this vicious cycle. And it really isn't broken until you do treat it topically.

Scott Webb: Yeah, I see what you mean. It's like this sort of vicious cycle, that we're contributing to our own misery in a way. So I'm assuming, as you mentioned treatment, there is treatment for eczema. I think the main question is because again, as you continue to see folks have this in adulthood, is that treatment permanent or is it sort of a temporary phase?

Dr. Daniel Hekman: As this is most common in children, our skin does thicken and we produce more natural oils as we age. And so this kind of fills in the gaps of that leaky skin barrier, which then naturally treats it. So essentially, people generally grow out of this eczema condition. But in childhood, to basically treat it, you first want to prevent it. So you want to fill in the gaps of that leaky skin with a natural moisturizer, free of fragrances, such as CeraVe products or Vaseline. If it does progress to the actual redness and itching stage, you want to basically pop the inflammatory cells with a topical corticosteroid.

Scott Webb: All right. You know, I'm just thinking this through a little bit. That sounds unpleasant for children, of course. But as you say, if it's treated, perhaps treated early, treated properly, then maybe it's not something that persists for the rest of someone's life, hopefully, right?

Dr. Daniel Hekman: Yes, in childhood you tend to see more flares in the drier seasons, like in winter. And so you do just have to try to prevent it with moisturizing. But if that fails, you have to periodically treat it with topical steroids. And depending on the individual, it can be more or less severe. But as I said before too, it can improve with age. So as the skin thickens and gets more natural oils, they should grow out of it.

Scott Webb: Yeah, good to know. And let's switch up here and switch to acne. What essentially is acne? And are the things that we do, is it genetic family history or is it behavior and lifestyle? Is it a whole combination of things that leads to acne?

Dr. Daniel Hekman: Acne, or it's really called acne vulgaris, which in Latin means common acne -- Well, to learn about it, we basically have to realize the normal function of skin. So your skin has a bunch of pores, as I'm sure most people are familiar with. And in those pores, there is released oily substance called sebum that acts as that natural moisturizer to coat the skin, to prevent it from getting dry and essentially to prevent eczema. So when this oil is either overproduced or when this oil becomes trapped in the pores by clumped dead skin cells, it becomes food for bacteria that are on your skin that then grow, lead to an infection that call in a bunch of inflammatory cells and that creates this pus-filled bump.

Scott Webb: Most of us commonly associate acne with teenagers, with adolescents, but you also see adults with acne as well. And so it sounds to me like for some folks, maybe this is avoidable; for some, it's not. What are you doing in terms of treatment? I'm sure there's a whole range depending on the type of acne and where it is and so on, but maybe you can cover the broad strokes.

Dr. Daniel Hekman: Correct. Yes. So teenagers, you see it most commonly because when those hormones start to increase, that actually directly stimulates increased production of this oil or sebum. So with more oil, you'll get more bacteria growth and then these inflammatory bumps. So for that sort of population, you can't really control their hormone levels. And so you basically try to control the bacteria by killing it with either some topical treatments or an oral antibiotic.

Scott Webb: And I'm sure for adults, who suffer from acne, you know, it's one thing for teenagers because it's expected. As you say, you can't control the hormones. They're a contributing factor in this. But for adults, in terms of self-esteem, confidence and so on, do you find yourself treating a lot of adults in the office? And do you do anything differently for them than you would for teens?

Dr. Daniel Hekman: I do. And there are several types of acne and there is a huge genetic component to it. So some people's skin just flakes more easily, and that skin gets stuck in the pores and creates acne more easily. So yeah, in adults, we typically do a topical vitamin A derivative called a retinoid. Many people may have heard of retinol products.

Scott Webb: for

Dr. Daniel Hekman: So, Yeah, so that kind of increases the turnover of skin cells and gets rid of those dead skin cells that hang around to prevent acne from forming. There's also other types of acne such as that flare, like in women around their menstrual cycle. And in those cases, we can sometimes use a medicine to try to decrease their hormone just a little bit. If it is so severe that the inflammation is so deep and causing cystic formation and scarring, there is the ultimate treatment that is high-dose oral vitamin A, also called Accutane available. So that should just be in the back of people's minds if their acne does get out of control.

Scott Webb: All right, doctor, let's switch up and talk about rosacea. I don't know a lot about this. I've heard of it. I think I can spot it. But from an expert here, maybe you can take us through this. What is it, what are the symptoms, what treatments are available and so on?

Dr. Daniel Hekman: So rosacea, the full name is actually acne rosacea. And I'm guessing the rosacea component is Latin for rose-colored. So it's really this redness, flushing appearance of people's faces as they age. And that can be associated with inflammatory bumps as well, which is where the acne part of that name comes from too. Would you like me to talk through how it develops?

Scott Webb: Yeah, let's do that. As you say, there's an sort of an acne component to it as well. But that redness, what causes it, do we know, how do you treat it and so on?

Dr. Daniel Hekman: Yes, there's two main types of acne rosacea. And to understand kind of the types and also how it's treated, let's learn how it arises. So there is a genetic component, but essentially it's from chronic sun damage. So the UV rays damage the skin and create these little microscars in the skin that then changes the architecture and cause the skin to regrow abnormally. Sometimes this traps the secretions and also causes the blood vessels to become very torturous or twisty and show up more easily underneath the skin.

Scott Webb: That's really interesting. It's so great to have experts on to understand this, because I've often wondered what is that exactly and what causes that. Are there things that we do? You said ~there's a maybe a genetic component of the things that we do that contribute to this, that further this? And what are you doing? What can you do to help folks?

Dr. Daniel Hekman: So it depends what type. So if the regrowth of these skin cells are trapping secretions and creating inflammatory bumps, then we want to treat it similar to how we treat acne vulgaris, which is usually a topical antibiotic to try to help calm down the inflammation and kill the bacteria causing these bumps. If it is an abnormal growth of blood vessels called telangiectasias, we want to try to treat basically the flushing part of that. So make the blood vessels smaller. And also, avoid foods and environmental triggers that can flare the blood vessels and cause them to get bigger.

Scott Webb: Gotcha. So again, as we were talking through things today, whether it's acne or eczema, so there are things that can be done. There is treatment available, even if it's just to control the flare ups or tamp down the flare ups, which is good to know. Let's switch a little more seriously now to skin cancer. And if we have a particular growth, does that automatically mean that's cancer? How do we know the difference between harmless things and more cancerous ones?

Dr. Daniel Hekman: So most often it's not cancer. Most growths are benign. But you always want to err on the side of caution, especially if you're concerned. But typically, the benign growth that we most commonly see are these slow-growing collection of healthy cells. So it could be skin cells, blood vessels, oil glands or basically appearing as skin tags or these kinds of waxy stuck on barnacles as they're called.

Scott Webb: Barnacles.

Dr. Daniel Hekman: Yes, affectionately termed age barnacles, the seborrheic keratosis, that's probably what I'm asked the most commonly in clinic if it's cancer.

Scott Webb: Yeah. I've got a few of those barnacles. I think I refer to them to a dermatologist, "What are these little crusty things?" And she's like, "Ah, those are fine. Those are normal." I was like, "Okay, good. Because they weren't there at one time in my life and now I have the barnacles, doc." Oh my gosh. What about freckles and moles and those types of things? It's just like, as we get older, you just look and go, "Hey, I didn't used to have that there." What is that exactly? And should we rush to the dermatologist to be checked out if we have one of those things that we didn't use to have.

Dr. Daniel Hekman: For moles specifically, so those are a collection of pigment cells that grow and the way we determine if they're concerning or not, is first of all, does that lesion that you're looking at, does that stand out from the rest of your moles? If it does, that could be a little concerning, if it's the ugly duckling mole.

And secondly, we use this ABCDE criteria. So the A stands for asymmetry. Is it not symmetrical-appearing or kind of irregularly shaped? B as for borders. Are there kind of irregular borders or ulcerating borders? C is for color. If there's multiple colors involved, that's more concerning. D is for diameter. If it is larger than half a centimeter, that is concerning. And finally, E is for evolution. So is it rapidly changing over time? Is it causing itching that it wasn't causing before or bleeding when it didn't used to bleed?

Scott Webb: Is one of the complications with things like this, that what may be normal for one person, you know, is sort of abnormal for someone else? So when you look at someone and they have a particular type of mole, but they have more than one of them, do you say, "Oh, that's normal for you. And we'll keep an eye on it." But if you see only one of those on someone else, you go, "You know, that's not like your other moles. Maybe we should biopsy this or whatever." Is that one of the complications for you, is trying to figure out what's normal for a person, you know, an individual?

Dr. Daniel Hekman: That's exactly right. Yes, if something sticks out clearly, and like I said, it's the ugly duckling mole and appears to be changing based on those ABCDE criteria, we will likely want to biopsy or sample that and look at it under a microscope to make sure that it's not cancer. Whereas if someone has a bunch of moles on their body, they are at higher risk of having a skin cancer, but we will look to see if one stands out more than the rest.

Scott Webb: Definitely. This has been really educational today. I have just a couple more questions for you. I'm 53, so I'm not quite a senior yet, but I am a member of AARP, because I wanted the free tote bag. Anyway, so when we think about, as we get older and especially seniors, they tend to have thinner and drier skin. Is there anything that they can do about that? Is there anything that we can do when we're younger to maybe not have that thinner drier skin as we age?

Dr. Daniel Hekman: Two words, Scott. Sunscreen.

Scott Webb: Yes. Sunscreen.

Dr. Daniel Hekman: I know you've heard this a lot, dermatologists sound like broken records in saying it. But it is true. So the sun UV rays do damage the skin and basically cause scarring and take away a healthy, fatty protective barrier underneath the skin. So that thins your skin over time with the more exposure to the sunlight.

Scott Webb: Yeah. And I harp on that with my kids. My kids are 14 and 19 and they actually both went away for spring break to warm climates. And I said, "Please use sunscreen." And they kind of roll their eyes at me. And I said, "You'll thank me later." I may not be around for you to thank, but when you're older and maybe you don't end up with skin cancer or you don't have the thin dry skin, you can say, "It's so good that we listened to dad and we use sunscreen even when he wasn't around to police it," right?

Dr. Daniel Hekman: Very true. And when you're thinking about SPF, you want to go at least 30 plus. The absolute best protection is obviously physical protection, like a wide-brimmed hat or UV shirts. But I also really like zinc oxide. It can leave you looking pretty white, like a ghost, but it does protect the most.

Scott Webb: Doctor, as I said, this was really educational and fun today. Is there anything that we can do to eliminate wrinkles, to prevent them? I hate to focus on aesthetics and appearance. But let's be honest, when you get to a certain age and you look in the mirror and you think, "Geez, these things here around my eyes, these things didn't use to be here. Should I have done something?" I know what your answer's going to be, "Yeah, you should've worn sunscreen." But besides that doctor what else can we do to prevent wrinkles?

Dr. Daniel Hekman: So, yes, that's exactly right. So interesting enough, the same treatment for acne, retinol products, believe it or not cause skin rejuvenation and take away some of those fine wrinkles in your skin because they increase the turnover and get rid of those old wrinkly cells.

Scott Webb: Yeah, this has been really great, doctor. And I think my takeaways and I'm sure for listeners are as well that sometimes it's genetics and family history, sometimes it's behavior and lifestyle. A lot of times, in fact, maybe in all cases things can be looked at, can be treated. We have experts like yourself to help us get through this stuff. And we need to do our part. We need to wear sunscreen. We need to protect our skin. We need to reach out to a doctor when something doesn't look right or feel right. So doctor, thanks so much for your time today. You stay well.

Dr. Daniel Hekman: Thank you so much, Scott, for having me.

Scott Webb: To learn more about common skin conditions, visit franciscanhealth.org and search skin conditions.

Host: And if you found this podcast to be helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.