We are happy to announce that DERM Lab is open in North Vancouver and we are seeing patients for in-person visits as well as select virtual visits. It hasn’t been quite the opening that we imagined, with the arrival of COVID-19 coinciding with the initial opening of our doors!  Now, after almost two months of mostly virtual visits and seeing urgent cases in person, we are happy to be able to welcome patients safely to our bright new clinic. We have put in place safety strategies including pre-screening patients to ensure everyone is feeling well on the day of their appointment, mask wearing by everyone who enters the clinic, and hand sanitizing upon arrival. We are also taking extra cleaning precautions and operating at a lower patient volume than usual to allow for physical distancing of our patients.

We appreciate your patience while we catch up on the appointments that had to be rescheduled over the past two months, and we look forward to welcoming you to the new DERM Lab!

See here for location and details.

In partnership with two trusted colleagues and Well Health Technologies we are in the thick of building a dermatology practice in Central Lonsdale to meet all of your medical and cosmetic dermatology needs.

We hope to be open by early 2020 at our new location. In the meantime I have select dates available for cosmetic dermatology consultations, Botox, and fillers at a temporary location (see Contact for details). Once we are established in our clinic, we plan to offer skin care sales and laser services to meet the full spectrum of your dermatologic care.

I am also accepting referrals for medical dermatology consultations, with a wait time of approximately 4 months at the time of writing. Please note that I do not see private consultations for medical skin conditions- these must be addressed first with a primary care provider and are seen by referral only. Medical skin conditions cannot be addressed at a cosmetic consultation.

If you have been wondering about rejuvenating your skin or improving your skin health, now is the time. I look forward to meeting you.

It seems this time of the year sunscreen is on everyone’s mind. Patients, friends, and most recently CNN have been asking me questions. See the link to the CNN article here:

Dr. Kuritzky interviewed by CNN

I will keep this simple, because it really is so. Here’s what you need to know:

1. Never burn, try not to tan- there is no tan without sun damage (read: wrinkles, skin cancer). That is a fact.
2. Spray on tans and tanning creams are safe, but don’t protect you from the sun- use sun protection also.
3. Sunscreen is only PART of your sun protection strategy: start with clothing, a hat, and sunglasses.
4. Choosing your sunscreen: minimum requirements:
   1. SPF 30 is the absolute minimum. I can’t believe they still make SPF 15. If you can find a higher SPF product that you like- go for it, the higher the better- the higher the SPF, the more UV rays are blocked
   2. Look for the terms “broad spectrum” and “UVA and UVB”. SPF only tells you how well the product blocks UVB, but UVA is just as important.
   3. Apply lots. I mean LOTS! Studies show most of us apply 1/4 to 1/3 the amount they use in the lab- so we are getting only 1/4 to 1/3 of the SPF. This is why the higher the SPF the better.
5. Enjoy the sun safely! This isn’t about hiding from the sun or living an inactive life. I take my family to the beach, and we spend a lot of time outside- we do it with hats, sunglasses (very important for kids!), and lots of sunscreen.
6. What is the best sunscreen? Within reason, I believe you get what you pay for- the higher end drugstore brands are worth it. Truth be told, the best sunscreen is the one you are willing to use. The photo above is a selection of products lying around my house if you need to know brand names 😉

Happy summer everyone!

There has been a lot of media attention recently on a hot new beauty trend: microblading. From rave reviews and exclusive salons, to warnings from provincial health, it can be hard to know- is this technique safe? Is it effective?

This topic is so hot, I was asked to do a short segment about it on Global News with Sonia Sunger:

Although as a medical and cosmetic dermatologist I do not perform this technique, I will distill what I have read and learned about it for you here.

How is microblading different from cosmetic tattooing?

Cosmetic tattooing uses a tattoo needle and ink to deposit ink in the the mid to deeper dermis (the structural layer of skin), where it stays, more-or-less permanently. Colours can change, fade, or become blurred over time, but the pigment is permanent, requiring specialized procedures like laser treatment for removal.

Microblading uses a fine blade- a scalpel- to introduce pigment more superficially. This superficial placement is what makes it semi-permanent, lasting anywhere from 1-5 years. Many salons recommend a yearly touch-up, but keep in mind that it can take several years to fade, so it is important to decide if this is the right treatment for you.

There was a warning recently about the possibility of getting a blood-borne infection from this treatment- how can I avoid this?

It is important that your brow artist adheres to the same sterility techniques that a doctor would use for a minor surgical procedure. This means using sterile equipment that is both single-use and disposable, or that is sterilized under medical-grade sterilization between clients. Not just the blade, but also the pigments and the container they are mixed in must be sterile. The practitioner should wear gloves and use clean technique. Even with the use of sterile equipment, skin infections could arise after treatment. Signs of this could include spreading redness or increasing pain after the procedure.

Is it painful?

It could be, so your brow artist should have a plan for how to deal with this. If a topical anesthetic is suggested, be sure you are clear about how to apply, how soon before your appointment, or whether it will be applied in the salon.

How do I assess my brow artists’ credentials?

As with any aesthetic treatment, familiarize yourself with the training programs that are available in your area, and decide which ones seem the most credible. There is no nation-wide standard in accreditation of training programs or facilities, and there can be wide variations in the cost and time spent on training programs. Your brow artist or their staff should be able to tell you where the artist trained. A useful question to ask is what possible complications may arise, and how are these handled? A professional should know not just how to provide an excellent treatment, but how to handle any complications that could occur. Also, ask to see some before and after photos from your artist’s work.

How long should the treatment take?

From what I have read, this sounds like a meticulous procedure. Simply marking the shape of the brows can take up to one hour, and this is arguably the most important step, where you will decide upon the shape you want your brows to take, and your artist will determine symmetry and make sure movement looks natural. Most salons state that the initial appointment will be 2-3 hours.

How do I prepare for treatment?

Your brow artist can give you details on what they require. Some prefer that you do not have any active neurotoxin, such as Botox®, at the time of treatment, as they will wish to study the natural shape and position of your brows. Let your cosmetic dermatologist know if you are planning microblading of your brows so that you can time it correctly.

Who should avoid this treatment?

Most salons avoid treatment if you are pregnant or breastfeeding. If you are undergoing major medical treatments such as cancer treatment, most salons also do not recommend it. Furthermore, if you have ever had an allergy to hair dye, henna tattoo, or tattoo dye, beware: having allergy to one type of dye can predict reaction to another, as they may contain the same or similar ingredients. Some salons offer a “patch test”, which they often recommend doing 24-48 hours before the treatment. This does not make any sense! Patch testing is testing for contact allergy, which is a delayed phenomenon- meaning it can take up to 7 days or longer for a spot of eczema to develop under the patch. A negative patch test also does not rule out future allergy, as allergy can occur at any time, so if a client was previously tolerating a treatment or had a negative patch test, but develops redness and itching, they should see a dermatologist for assessment before proceeding with any further treatment.

If you have had experiences with microblading I would love to hear from you- please comment below!

With many medical professionals performing cosmetic treatments, how do you choose the one that is right for you?

What to look for:

1. Check credentials. Dermatologists have the designation FRCPC (Fellow of the Royal College of Physicians of Canada), and have 5 years of residency training in skin health. Here is why I feel strongly about this: the health of your skin is paramount- your cosmetic doctor should be able to diagnose and treat skin disease as well as perform cosmetic treatments.
2. Who performs the treatments? Does your doctor perform injections themselves, or do they delegate them to a nurse or another medical professional? I perform my injections myself because I believe this is the safest way to deliver reliable and natural-looking results for my patients.

The initial consult:

1. Your dermatologist will likely have a fee for a cosmetic consultation for a new patient. This allows us to spend the necessary amount of time with you to give you a thorough consultation and to fully address your concerns and answer your questions. This is a sign that your cosmetic physician is an expert in their field, someone who understands how valuable time is and wants you to get the most from your investment.
2. An expert will assess you as a whole. Does your provider simply address your concerns, or do they take the time to give you a comprehensive consultation? You might be most concerned about crow’s feet or nasolabial folds, but there may be areas that would benefit from treatment that you are not aware of.
3. Tip: Don’t be shy- tell your injector if you have had any treatments in the past. This is a very important part of our planning process to give you the best results safely.
4. Seek to understand why. Does your doctor explain why they are suggesting their treatment plan, and show you what they hope to accomplish using photographs and/or a mirror? Can they break it down into a series of treatments and explain what they hope to accomplish with each one?
5. What do I do if my doctor says no to my request? For example, you might request lip enhancement, and your doctor might feel this is not the best place to start. This means they are considering you as a whole. Maybe they have noticed that you would benefit first from treatment of your cheeks and chin, structures that are essential to support your lips. Ask them to explain their reasoning, and why they are recommending their approach. Look for an emphasis on natural-looking results.
6. Expect to spend some time talking about possible complications. This is medicine, after all, and as with all medical treatments, there are potential complications that you need to be aware of. While you might prefer not to talk about this, a good injector will review it with you. This shows you that they have an advanced understanding of anatomy and how to handle situations that could arise.
7. Tip: Don’t be afraid to ask questions. A good injector understands that you may have lots of them, especially if you are a new patient.

Making and following your plan:

1. Is your physician sensitive to your financial plan? Treatment plans can seem overwhelming at first, but can be broken down into several visits. This has the added benefit of allowing you to obtain your new look over time.
2. Does your injector suggest the same thing over and over? While injections of neuromodulators like Botox® are often kept stable, they do require periodic reassessment. Injection of fillers requires constant re-consideration to take into account facial changes and response to previous treatments. If the same treatment is suggested repeatedly, ask why. There may be a good reason; whatever the case, your doctor should be able to explain it to you clearly.
3. Tip: ask ow accessible your doctor is. How do they handle problems or concerns after hours? Make sure you understand how to contact your doctor if necessary.

Finally, trust your instinct. You should feel confident with the physician you choose.

This article is intended to provide general information and is not intended as a substitute for assessment and care from your doctor. 

A topical retinoid is a powerhouse in your medicine cabinet and your cosmetic bag. Why? The science behind regular use of a retinoid cream shows they can decrease fine lines, improve hyperpigmentation, and smooth your skin. They may even offer some modest improvement for scars. For those of us that are acne-prone, they also help tame breakouts (this is their original indication and the most common reason I prescribe them).

However, starting a retinoid (a topical vitamin-A derived treatment) can be a frustrating experience initially, as it can cause dryness, peeling, and even the odd acne breakout. Here are some tips to help you “retinize” your skin with ease.

1. Go slow! Start out just 2 nights a week for 2 weeks, or until you are confident you are tolerating it without too much dryness or peeling.
2. Apply in the evening. Many retinoids are not light-stable, meaning they do not perform as well when exposed to sunlight. This is why evening is the best time to apply.
3. First, wash your face with a gentle cleanser such as Dove bar for sensitive skin or Cetaphil gentle facewash.
4. After washing, apply a gentle unscented moisturizer such as Toleriane Ultra or Fluide by La Roche-Posay or Neutrogena Hydroboost.
5. Wait a few minutes (at least 5) until the moisturizer is dry- this is a good time to brush teeth and go through other nighttime rituals.
6. Now, apply a small pea-sized amount of the retinol or prescription-strength retinoid (if this has been prescribed by your doctor) to the entire face. Yes, one small pea-size is enough for the whole face. Dot it across your forehead, cheeks, nose and chin, then spread evenly across the skin. Avoid the area around the eyes, as this can be extra sensitive. Continue to do this 2 nights per week.
7. After 2-4 weeks, if the skin is not too dry or irritated, increase your use to every second night, and after another 2-4 weeks increase to nightly use once you are tolerating the product. Don’t be afraid to go slow.
8. Those with dry and sensitive skin may need to progress through these steps more slowly. If you overdo it, fear not- take a break for a few nights and use a moisturizer until your skin recovers, then start again but use it less frequently for a few more weeks. It doesn’t matter how long it takes you to get to nightly use- the key is not to overdo it initially, and to stick with it even if you need to take a break.
9. Wear a daily broad-spectrum sunscreen with an SPF of at least 30, re-apply when you are outdoors, wear a hat and try to stay in the shade. Retinoids improve the health of your skin, but they thin the “dead” layer of skin cells, leaving your skin slightly more vulnerable to the effects of the sun, so protect yourself.

If you do not experience peeling or dryness at all, question the efficacy of your product. Depending on the exact molecule and the concentration, efficacy can be different. Once you have “retinized” to your product, you may tolerate an increased percentage. Your dermatologist can help you chose the right product, and will know if your skin is ready for a prescription-strength retinoid.

Topical retinoids are safe and most beneficial when used long term, so once you are using it regularly, keep it up! Be aware, in most cases they should be stopped during pregnancy and breastfeeding- your dermatologist can discuss this with you.

This article is intended to provide general information and is not intended as a substitute for assessment and care from your doctor. 

Ever wonder what products make the cut for your dermatologist’s 1L liquids travel bag?

If you are like me and rarely check a suitcase, traveling forces you to reconsider your skin and hair care routines and whittle them down to the essentials. That little 1L bag doesn’t look like much but you can get a lot in there with a little thought. Let me share with you which products I can’t be without, what I can leave for a few days, and little tricks to help you get the most out of your 1L bag.

First: utilize solids wherever you can.

Dove Bar for Sensitive Skin: if you’ve spoken with me about skin care, you know this is my favourite cleanser. No less for travel- this is my all-in-one facial cleanser, body wash and shaving product. That’s two less liquids to worry about.

Secret Baby Powder Solid: my choice deodorant.

La Roche-Posay Lipikar AP+ Stick: my best new travel find- a moisturizer in a stick! It looks like a little solid deodorant, but slides right onto your still moist post-shower skin as a moisturizer. No more making do with scented hotel moisturizer.

Now for the details: what actually goes in the bag? Here are my picks, item-by-item:

Shampoo: I found these adorable sample bottles from Kevin.Murphy, and they are key. These little cubes easily hold enough shampoo for a week, even if my hubby uses some, and they stack up easily in the bag. My current fave shampoo and conditioner is Moroccanoil, but these cubes can be refilled with whatever product you prefer.

Oribe Supershine Light moisturizing cream goes in a travel-size bottle (the purple one).

SkinCeuticals CE Ferrulic vitamin C serum: this comes in a small enough bottle that I bring it as is, though they do make even tinier sample bottles that could easily be refilled for travel.

SkinCeuticals Metacell B3: this is my favourite daily moisturizer, but it comes in a heavy glass bottle. So here’s the trick: when you are getting low, pull the pump out of the glass bottle- now you have a thin, light plastic pump- I save this one for travel and move on to a new one for use at home.

EltaMD UV Daily SPF40: you know how I feel about sunscreen, so it won’t surprise you the full product follows wherever I do.

La Roche-Posay Toleriane Ultra Moisturizer: thin and light, this is one of my favourite nighttime moisturizers and the retail bottle is perfect for travel.

Latisse prescription eyelash growth product: this comes in such a small bottle that slipping it in the 1L bag is easy.

Retinoid: these tend to come in small tubes, so your product of choice is likely to fit in your 1L bag. Your dermatologist may also have small samples to help you out.

Toothpaste: I save the samples I get from the dentist for my travel bag.

So what stays at home?

Clarisonic MiaFit Cleansing Brush. As much as I love this device, it is a bit heavy and requires another liquid- a foaming face wash- so I do without it for a few days.

Shave gel: too bulky, and many hotels will provide this on request. If not, Dove Bar Sensitive works quite well if you really lather it up. Just remember to use the Lipikar AP+ Stick afterwards.

If you have a 1L bag travel tip I would love to hear it- please comment below! I wish you healthy skin and happy travels.

Athletes push their bodies to the limits of their endurance- and this can pose some challenges to their skin. Inspired by my husband who is out doing the Whistler Iron Man 70.3 today (Go Danny!) here are a few tips for your skin  to help you achieve your best.

1. Don’t get burned! Protect yourself from the sun. It will come as no surprise to anyone who knows me that this is my number one tip. Here is why: obviously, many athletes spend a good deal of time outdoors, and need to protect themselves from damaging UV rays. But here is a more immediate argument: have you ever had a sunburn? Did you feel you could perform your best? When you are sunburned, your body is spending energy- valuable energy-recovering. Your skin barrier is also compromized, so you are losing more water through the skin- not what you want on race or game day. For a long race or game, apply a double coat of a high-SPF (30+), broad-spectrum, UVA/UVB product. Reapply during your activity if at all possible. And don’t forget your lips! This is not just for race or game day, but all the time- especially leading up to the big day.
2. Get out of those sweaty clothes! After training, get out of your tight, sweaty clothes ASAP. This will help to minimize chafing and prevent folliculitis. Your technical apparel is for training in- stretch and relax in something loose, clean and comfortable. Your skin and your high-tech gear will thank you for it. Showering soon after training will also help to minimize skin irritation.
3. Did I say chafing? If you are a long-distance runner or cyclist, using some Vaseline or other anti-chafing product can help prevent those sore, rubbed red-raw spots. For cyclists, putting an anti-chafing product on your chamois can make sure you are comfortable for all those KMs. Try Chamois Butter, dznuts, or Udderly Smooth Chamois cream. Having your seat fit properly is also paramount!
4. Take care of your feet. Make sure your shoes fit properly and are appropriate for your activity, to relieve pressure and prevent callus formation. Gently using a pumice stone in the shower, followed by a moisturizer, can help too, but don’t be too aggressive. Best to prevent these in the first place with proper fitting footwear and orthotics if necessary. Keeping toenails trimmed, and changing socks to keep feet dry is also key.
5. Stay hydrated. Normally, I don’t make too much of a fuss over how much water to drink- but for athletes, it goes without saying that hydration and electrolytes are key, for your entire body including your skin.
6. Protect your eyes from UV. Many activities requires specific eye wear, but whatever you are doing outdoors, make sure you are wearing eye wear that protects you from UV rays.

This article is intended to provide general information and is not intended as a substitute for assessment and care from your doctor. 

Last Saturday, the Canadian Dermatology Association, with Dr. Jason Rivers, Dr. Sunil Kalia and myself plus two very dedicated dermatology residents Dr. Saud Alobaida and Dr. Bez Toosi spent a few hours at the Vancouver Aquatic Centre for a very worthy cause: skin cancer screening.

This yearly event helps to promote awareness and make skin cancer screening accessible to the hundreds of people who came down and waited patiently to be screened. We were also handing out samples of sunscreen and some brochures for self-checks. If you missed the event, there is always next year! In the meantime, if there is something of concern to you on your skin, speak with your family doctor- they can help you determine if you need a referral to a dermatologist.

For self-checks at home, remember the ABCDE rule posted back in February in ABCs of Moles:

• A: Asymmetry– this describes moles that don’t look the same on both sides if you imagine dividing them in half
• B: Border irregularity– a border with notches or an irregular outline
• C: Colour variation- moles with more than one colour
• D: Diameter– greater than 6mm; the size of a pink eraser on the tip of a pencil
• E: Evolution– a mole that is changing rapidly, for example from one month to the next, or changing differently or faster than other moles.

This rule is meant to help detect melanoma. Of course, basal cell and squamous cell skin cancers and other, rarer types of skin cancer can present differently. Any growing pink bump, or a growing spot that stands out from your others deserves to be checked.  The “ugly duckling” rule helps you catch these- if there is one spot on your skin that doesn’t match any others, especially if it is growing or changing, show it to your doctor.

Suddenly summer is in full swing and it’s time to dispel some common myths about sunscreen.

Do I need to wear sunscreen daily, even in winter or if I work inside?

Yes! UVA passes through window glass and is more consistent throughout the day and throughout the year than UVB (which tans and burns you). UVA also contributes to wrinkles and other signs of aging, along with skin cancers. What’s more, even short exposures outside add up throughout the day, so daily sunscreen use is a good habit to develop.

What sunscreen should I buy?

Look for a product that states: SPF 30 or higher, broad spectrum, UVA and UVB. SPF means sun protection factor and measures how long a sunscreen will protect you from UVB rays. Broad spectrum products protect against both UVA and UVB rays. Higher SPF provides better protection by blocking more UV rays.

 What about Vitamin D- do I need to get it from the sun?

There are three sources of vitamin D: supplements, fortified foods, and the sun. Usual sunscreen use does not interfere with vitamin D production but rigorous use of sunscreen and clothing may. The best strategy is to protect yourself from the sun and to take a daily vitamin D supplement of 1000 IU, with food. That way you get the best of both worlds, safely.

Is there truth to claims that sunscreens can disrupt our hormones?

These concerns are based mainly on a 2001 study in which female rats were fed huge amounts of oxybenzone, one of the ingredients in chemical sunscreens, and were shown to have an increase in the weight of their uterus. A 2011 study demonstrated that a human would have to use sunscreen in normal quantities daily for 277 years to reach these levels. This shows that the original study does not hold true meaning for human application of sunscreen.

What is the difference between chemical and physical sunscreens?

Chemical sunscreens, which typically contain ingredients such as oxybenzone, octinoxate, octisalate and avobenzone absorb UV radiation, which is then released from the skin as heat. Physical sunscreens, which contain zinc oxide and titanium dioxide, both reflect UV radiation and absorb it.

Which is better – physical or chemical sunscreens?

For people with sensitive skin or a history of allergy to sunscreens, physical sunscreens may be better tolerated. For most, it is a matter of personal preference. Physical sunscreens may appear more white on the skin while chemical sunscreens are often more transparent. Some physical sunscreens are tinted to better match skin tone.

 What approach to sunscreen is recommended for children?

All sunscreen ingredients available in Canada are approved for use in children six months of age and older. Sunscreen labeled as “Kids” or “Babies” do not have different sunscreen ingredients, but may have certain properties such as water resistance. Babies under 6 months of age should be kept out of direct sunlight, and need a vitamin D supplement.

 Is any sunscreen truly waterproof?

Canadian labeling standards allow the terms Water Resistant 40 and 80, meaning that the product has been tested to retain its SPF after 40 or 80 minutes of water immersion. Sunscreens may not be labeled as waterproof and should be reapplied after swimming, sweating or toweling off.

 How much sunscreen do I need to apply?

The teaspoon rule helps you apply enough sunscreen to match what is done in the lab when SPF is determined. Apply ½ to 1 teaspoon to the face, 1 tsp to each arm, 1 tsp to the chest, 1 tsp to the back, and 2 tsp to each leg. That’s almost 45 mL, or about a shot glass, of sunscreen per application in a bathing suit.

Apart from sunscreen, what else should I do to protect myself?

Wear a broad-brimmed hat and cover up with clothing wherever possible. Clothing labeled as UPF means UV Protection Factor, a similar concept to SPF, and is good for long sun exposure and beach wear. A “UPF 50” shirt blocks 98% of UV rays. Protect your eyes with sunglasses or prescription glasses whenever you are outdoors. Plan activities early in the morning and later in the afternoon, avoiding mid-day sun.

Get out there and enjoy the sun safely- your skin and eyes will thank you for it.

This article is intended to provide general information and is not intended as a substitute for assessment and care from your doctor.