Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
Expert Tips for Safe and Effective Laser Procedures
Discover the transformative power of laser treatments in dermatology with Dr. Taryn Murray from Cleveland Clinic. Whether you're dealing with rosacea, scarring, wrinkles, or sun damage, Dr. Murray's deep dive into the mechanics and benefits of laser technology will leave you empowered with knowledge.
But the conversation doesn't stop there. With insights on the crucial role of selecting experienced, board-certified dermatologists, Dr. Murray also sheds light on the risks associated with inexperienced practitioners and med spas. Tune in for a comprehensive exploration of how to achieve optimal skin health and appearance.
To make an appointment with Dr. Murray, please call 216-444-4004. You can follow Dr. Murray on Instagram @tarynmurraymd.
For more information on certified dermatologists nationwide, visit aad.org.
Welcome to the Fit, Healthy and Happy Podcast hosted by Josh and Kyle from Colossus...
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Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, and I am back in the Sunflower House for a brand new episode and on this episode I am going to be interviewing Dr Taryn Murray to talk about cosmetic dermatology. So, based on our two seasons of podcasts, some of our favorite podcasts, and most downloaded ones, involve skin, hair and beauty, which is not my area of expertise. I'm a menopause women's health specialist but women are interested in, of course, how they feel and how they look. So I want to tell you a little bit about our guest.
Speaker 1:Dr Taryn Murray is a cosmetic dermatologist at the Cleveland Clinic Foundation in Cleveland and she graduated from Northeast Ohio Medical University for medical school and then she went on to complete her dermatology residency at the University of Illinois at Chicago and then she completed an American Society for Dermatologic Surgery accredited cosmetic dermatology and laser surgical fellowship in Houston, Texas. And Dr Taryn Murray's main cosmetic interest is in the use of lasers, especially with laser resurfacing for sun damage, wrinkles and scarring resurfacing for sun damage, wrinkles and scarring. And when Dr Murray is not working, she's usually spending time with her husband and her pets, and I understand that one of her pets her dog is a little ill at the moment, unfortunately, and she really enjoys volunteering at animal rescues and also gardening. Welcome, dr Murray. Thank you for having me. So we're going to talk about a lot of different topics that women are interested in, and probably men too, and we want to talk about lasers and laser therapy and how it can improve the skin. So first, why don't you tell us what is laser treatment?
Speaker 2:So I don't want to get too technical, but the term laser is an acronym that stands for light amplification by stimulated emission of radiation. Essentially, lasers are devices that deliver energy to a desired target through a specific wavelength of light. Essentially, lasers are devices that deliver energy to a desired target through a specific wavelength of light. Different targets absorb different wavelengths of light and through this process, energy is delivered to the target. In dermatology, when we deliver laser energy to a target, the energy is converted to heat and that is what achieves the desired effects that we see in the skin. Lasers in dermatology can be used to target various components of the skin. We can target things that are red, such as vascular lesions or tattoos, things that are brown or black, such as sunspots or birthmarks. Of course, we can target other colors, like when we remove various tattoo inks, and we can also target various depths within the skin, such as the epidermis and dermis, which are the top layer and the deeper layer of the skin, depending on what conditions we are looking to treat.
Speaker 1:Wow, so that's an awful lot. The only personal experience I've had with lasers is for rosacea. Before my son, my second son, got married. I just had this flare and my nurse who's retired Nurse Lily, who our listeners have heard me interview about retirement and catching up with Nurse Lily interview about retirement and catching up with Nurse Lily. She had told me that earlier she had undergone a laser for rosacea, which is considered cosmetic so insurance doesn't cover it, and she said it just made a dramatic improvement in her skin. And of course I wanted to get ready for the wedding. So I had that done and so I was very I was very pleased with the results. What are some of the most common things that women or men or patients or even children come to see you to have laser done?
Speaker 2:Yeah, so treatment for rosacea is definitely one of the most common procedures that we do, but lasers can treat a wide variety of dermatologic issues. We have resurfacing lasers. These work by delivering microscopic columns of heat to different depths of the skin. So when we deliver heat to the skin like this, it triggers a remodeling of the collagen that we have, so it's stimulated to rebuild itself back up stronger and tighter and it stimulates formation of new collagen and elastin. Increasing the collagen content in the skin helps treat many conditions, including different types of scarring, wrinkles, fine lines, pore size and overall skin tone and texture.
Speaker 2:We also do tattoo treatment very often. There's lasers that treat tattoos and other pigmented spots, like brown birthmarks and sunspots. These lasers work by delivering energy so quickly to the target that they'll shatter the tattoo ink or melanin pigment into extremely tiny fragments. Then the immune system clears these ink particles away or the melanin pigment will be exfoliated through skin cell turnover. We have vascular lasers, like you mentioned, that work to treat vascular conditions like rosacea, various red spots, vascular birthmarks. These work by heating up the blood, coagulating it and closing down the blood vessels. The body will then work to clear these away over the days to weeks following the treatments.
Speaker 1:Wow, so I know that there's been some information in the news about certain tattoo inks like green ink with tattoos being linked with a higher rate of cutaneous lymphomas and cancers. So is there a risk in blowing up that ink to get rid of it, to clear it up? I mean, does that cause further exposure? Do you know to the person who's trying to remove a tattoo they don't want anymore?
Speaker 2:So as far as I'm aware, it doesn't increase your risk of exposure to have tattoo removal treatment. Even placing the ink in the skin at all is going to stimulate the immune system to come to the area and work to clear the ink away. Doing the laser treatment is just further stimulating the immune system to remove the ink. However, even if we are able to remove the ink from the skin, it never truly leaves the body. Cells from our immune system will carry this ink off to lymph nodes, so it just moves away from the skin into lymph node tissue. But to my knowledge it doesn't increase the risk of any lymphoma or cancer to have tattoo removal done.
Speaker 1:But once you have that, I guess, ink in your body, even if you disperse some of it from your skin, it's still in your body. So it seems like you should be really sure you want to do this. In general, I would think.
Speaker 2:Yeah, it never really leaves you.
Speaker 1:Now acne is such a big problem and I don't think we've yet had a podcast solely devoted to acne. But in my practice at the Center for Specialized Women's Health for years I've gotten referrals from our dermatology colleagues for acne and hirsutism and hair thinning to try to fix the hormonal balance, and it always seemed to me that females, by virtue of us being able to control the ovaries and give hormonal contraception, of which we've had several podcasts on hormones have more treatment options sometimes than males who have acne. And my sons had acne and one of my sons had to go on Accutane, which is a very potent treatment. But I often thought that for severe scarring acne, whether it's a male or female, especially on the face, that some sort of resurfacing of the skin would be desirable by many. Is it a deeper laser or is it more intensive than like? Because it seemed like the laser treatment I got a couple of times for the skin rosacea seem pretty minor and in and out not a big deal.
Speaker 2:Yes, so different types of lasers work differently and target different depths within the skin. When we are treating a scarring condition like acne, we need a laser that is going to penetrate more deeply into the skin. And these work how I? I mentioned previously where we're delivering heat to the skin to stimulate collagen production. As we stimulate collagen production in the skin and there's a remodeling of our tissue, the body starts to replace areas of scar tissue with normal collagen and therefore normal skin. Of course, this is happening on a microscopic level, so there isn't any immediate dramatic improvement following these treatments. That collagen stimulation takes a little bit of time. It just takes the body time to do the work. But typically around four weeks after treatment patients will start to notice improvement in their skin and then there will be a delayed, slow, gradual improvement over the weeks to months following the treatment. It's typically something that requires multiple treatment sessions, but there is often noticeable improvement per treatment.
Speaker 1:And so, depending on the condition, I would imagine would depend on how often the person needs to have the laser treatment done.
Speaker 2:We typically space laser treatments at six to eight week intervals for a laser that's working to stimulate collagen, but patients could certainly wait longer than that in between if they wanted to. There's some evidence that suggests the collagen stimulation can be ongoing for up to several months or even a year following the treatment. So really we just work with the patient to find an interval that works best for them.
Speaker 1:Yeah, so again, everything is individualized. And on the rosacea front, if our listeners haven't listened to the podcast with a lot of the content by one of our graduates, Dr Tiffany Cochran, who has beautiful skin, who wrote on rosacea, there's a lot of medical treatments and I would think with most conditions, especially in the anti-aging realm, it's not just what you do to the skin, it's like your whole overall health, correct, Like I know. Of course, smoking is so detrimental to aging inside the body and smokers certainly look much older than their stated age. So does, do you know? Does tobacco accelerate collagen breakdown in the skin?
Speaker 2:Oh, it definitely does. Smoking accelerates collagen breakdown, as does UV exposure.
Speaker 1:And I know that some patients who come to see me who need surgical procedures that are considered elective, meaning it's not like an emergency appendectomy or an emergency surgery, that the surgeons won't operate on them unless they stop smoking, and I do believe that's also the case in the realm of certain types of plastic surgeries. Is that right?
Speaker 2:I believe you are correct. We will still do laser treatments on patients that are smokers. We counsel them that they should try to at least stop smoking for the healing period of the laser treatment. Especially for more aggressive treatments where the skin has areas that may be open, Smoking can delay the wound healing and just prevent the most optimal outcome from the treatment.
Speaker 1:Yes. Now, in terms of doing laser on children, I know that some children are born with birthmarks or stork bites or, I guess, hemangiomas. My sister had one on her, the lower part of her leg, which was not of any cosmetic issue. But if it's certainly on the face or the neck, that can be a big, a big deal, and I think sometimes they give beta blockers to help close those blood vessels. But I would imagine that some people don't get complete closure, and so is laser an option for people that have deforming or very prominent birth marks that bother them?
Speaker 2:Yes, so for hemangiomas, we can give beta blockers to help shrink the area of the hemangioma. However, some patients may still go on to need laser treatment. We also use laser treatment very often for other vascular birthmarks, such as port wine stains. These are procedures that are fairly common and in in these cases, the earlier you treat, the better the outcome is likely to be. The goal is to prevent these lesions from enlarging or thickening, and potentially preventing a functional impairment in some cases. Um, so the earlier you treat, the better, and it's not uncommon for us to treat infants that are only several days old.
Speaker 1:Wow, that's really early. So for parents or aunts or uncles or grandparents listening and there's a new baby that's born that has one of these birthmarks, I mean you wouldn't necessarily be thinking about cosmetic dermatology for a beautiful newborn, but actually that would be an example where that would be needed.
Speaker 2:Yes, and these types of treatments are often covered by insurance. These are some of the few that are Okay. That's good to know.
Speaker 1:Now what about with scarring? And I'm thinking about some of our patients of color who seem to get keloid scarring so much more frequently, and anyone actually like I know dermatofibromas a lot of times. Dermatologists don't like to remove those because then you just get a bigger scar keloids can be tricky.
Speaker 2:For certain lasers, having a keloid could be a contraindication to treatment. We just want to ensure that any treatment that we're doing isn't going to stimulate the tissue to enlarge further, as you mentioned. So keloids are definitely something that can be challenging and typically in these situations laser would not be the first step in the treatment plan, so you do like what injectables or yeah, we typically start with injectable treatment for keloids to calm down the inflammation and help shrink the lesion Interesting.
Speaker 1:And how often are you using lasers for just anti-aging, for wrinkle treatment on the face, the neck, the arms?
Speaker 2:Oh, we do these every day. These are very popular treatments. Every day, these are very popular treatments. Certainly, I would say full face treatment for rejuvenation. Wrinkles, fine lines, a little bit of skin tightening that's one of the most common things.
Speaker 1:So how does it work for the neck? My granddaughter, when I was putting her in the car the other day, looked at me and she said, Mimi, what's wrong with that skin on your neck?
Speaker 2:on your neck, so any lasers we use on the face can be used on the neck as well. Different settings may be used just because different areas of the body are not able to handle the same amount of energy delivery or might not be able to tolerate as aggressive as a treatment as others. Typically, the face is better at wound healing than other areas of the body, and people are able to receive more aggressive treatments on the face. Sometimes we will do face and neck treatments together, but often we are using slightly less aggressive settings on the neck.
Speaker 1:Now I was recently vacationing with my husband because we usually go away on his birthday and of course I like to get the spa treatments and the massage and just kind of relax and I noticed that they had like a quote medical spa and it looked like they were doing all sorts of medical things injections, lasers, et cetera and I'm thinking I wonder if these are like board certified physicians and how reputable is this? It seems like a lot of my patients are going to alternative practitioners and getting things compounded and I worry about unregulated things and, at least in the menopause realm, pellets we do not recommend and people are doing cash pay for that and we did a podcast with Dr Fific on the dangers of these unregulated hormones and pellets. I see it all the time. I see it in the obesity realm and so when I noticed this in the dermatology realm, I just wondered if you had any comments. Are they dermatologists that just go to spas and resorts? Should patients beware and just go to a standard medical facility?
Speaker 2:So I'm really glad you brought this up, actually, because I feel that this has become a huge problem. Unfortunately, with facilities such as med spas, there's very little oversight in terms of the training that people are receiving and the procedures that are being done. There are often people working there that are very inexperienced with little training and performing these procedures. There's often very little oversight at these facilities. This varies on a state-to-state basis, but some of these facilities do not even require a physician to be on site while these procedures are being performed, so there's very little supervision oftentimes, and I've seen some horrific complications coming out of facilities like medical spas. Oftentimes, those performing the procedures in these settings are not equipped to quickly recognize and manage complications, and that's where people tend to run into problems.
Speaker 1:Wow, so that's really important. Now you have been listening to the Speaking of Women's Health podcast and I'm your host, the Executive Director of Speaking of Women's Health, dr Holly Thacker, and on today's podcast we have Dr Taryn Murray, a cosmetic dermatologist at the Cleveland Clinic, well-trained board, certified expert in both cosmetic and non-cosmetic dermatology, making the point that there are cosmetic or alternative treatments, just like there is in the field of menopause, that a lot of women are attracted to, that aren't regulated, that may not have people, that are trained to recognize complications or be very holistic or comprehensive in the person's entire health, and it's kind of hard to look good if you're dead. So that's what I tell my patients, or feel good, I have so many women that feel like they're 30 and they want their sex drive great.
Speaker 1:And then they get these implants of testosterone which make them feel like they can take on the world and have an increased sex drive. But then it can stimulate the uterus. I've seen uterine cancer cases. They can get deeper voices and hirsutism and things that are not that easy to take care of afterwards. So I think we want to encourage women.
Speaker 1:Of course, Our motto is to be strong, be healthy and be in charge, but we also want you to be very critically thinking and very aware and be a really good consumer in terms of knowing who also want you to be very critically thinking and very aware and be a really good consumer in terms of knowing who you're going to, what products that you're spending a lot of money on. We've had two of the Cleveland Clinic skincare estheticians who sell like medical grade products and I love to go up there and buy these products who are very knowledgeable and understand what's important and what the regimen is just to take care of your skin, Because I'm sure what you do most days of the week in terms of nutrition, hormonal health, vitamin health, protecting against excessive solar exposure, not smoking, not drinking, getting your beauty sleep, all of those things are so important. I would imagine that you would endorse Dr Murray.
Speaker 2:Oh, absolutely. Any treatment you do in office is going to have an even better outcome and more optimal results if patients are leading a healthy lifestyle and using a skincare regimen that's tailored to them and their skin needs.
Speaker 1:And tell us about the different types of lasers that are available.
Speaker 2:Oh, there are many types of lasers available. We often group these into categories depending on what they treat. So I mentioned resurfacing lasers a little bit. So these lasers address skin texture. These can be divided into both ablative and non-ablative types. Ablative lasers break the skin barrier when they deliver the laser energy, whereas non-ablative lasers do not break the skin barrier. Because of this, ablative lasers trigger a much more robust collagen stimulation response and therefore can give you some extra improvement per treatment. The catch is these have a longer downtime and require some wound care following the treatment.
Speaker 2:Ablative lasers include things like CO2 or erbium-yag, which many patients have heard of before. Other types of lasers we have are those used to treat vascular lesions, which we mentioned. This one's most commonly the pulse dye laser. We have lasers for laser hair removal, lasers for hyperpigmentation, brown spots, tattoo removal, hyperpigmentation, brown spots, tattoo removal. But I want to make a point that when deciding which laser to use, you have to consider the condition that's being addressed and you also have to consider the patient's skin type. This must be taken into account because not all lasers are safe in all skin types. So I highly recommend that patients seek treatment at a reputable facility with a board-certified dermatologist who has training and expertise in these devices?
Speaker 1:Now I've had. I guess I have had one other type of laser besides the rosacea laser for little broken blood vessel veins on the legs. A couple of my aunts look like they have complete roadmaps on their legs.
Speaker 1:And I thought okay, I just kind of want to you know, have people not look at my leg for the map on where to go? And I've had sclerotherapy which I thought worked very well, but then the couple times I had laser it really hurt like hot oil hitting my leg and it didn't seem like it got rid of the little veins on the legs.
Speaker 2:So, unfortunately, leg veins are something that are very difficult to treat. We typically start with a series of injections and start by injecting the larger veins. We'll inject anything that we can fit the needle into and that typically will clear up majority of the veins. Sometimes there are very small veins that persist and these are too tiny for us to get a needle into, and that's when we often turn to laser treatment as sort of the next step, but it tends not to be very permanent. Sometimes we can't get all the veins to fully go away. Unfortunately, just the vein treatment is not there yet, like it is with some of the other conditions that we treat, but I'm hoping in the future we have some more effective treatments.
Speaker 1:That's really interesting, I mean. One thing that I recommend to all women is to support your veins If you're standing for long periods of time, if you have a family history of varicose veins. I wish that for my first pregnancy I would have discovered Sigvera's support hose and there's different brands. Jopst is, like you know, the real high compression one. There's various levels of compression, but just supporting the veins, particularly with prolonged standing, obesity, pregnancy, family histories of bad valve veins, because the more serious varicose veins medically we worry about in terms of blood clot and what I've told a lot of women who don't like some of the little broken blood vessels on their legs is there is such a thing as leg makeup, you know.
Speaker 1:So if you're going to wear shorts you can always do that. It's not permanent, but for some, you know, it's a fix. Do you do laser, which my beef as a women's health physician is? It seems like if someone has laser hair removal which I can understand if you genetically have some hirsutism on the face they think, oh, let me get my underarms hair done, let me get my pubic hair done, and then that hair is forever gone. And that's one marker that I assess adrenal function, because women who just naturally lose pubic hair and underarm hair many times are low in adrenal sex hormones, so I didn't know if you had any comments about that.
Speaker 2:So we do have a lot of patients seeking treatment for hirsutism, and this is something that I think is very sensitive for women and difficult for them to deal with. You know having facial hair. Oftentimes it's covered by insurance. Typically these patients have already seen a primary care physician or an OBGYN and had some sort of workup by the time they're making it to us. Usually we are not their first stop, but the laser hair removal treatment for hirsutism is typically very successful and women are often thrilled with the results.
Speaker 1:Yeah, I see it's like they get it done and they keep getting more and more and more and more done. I see that sometimes with people they get one tattoo, they and more and more and more done. Like I see that sometimes with people they get one tattoo, they get more and more and more done. If you could just walk us through what is the process if you're trying to get an appointment for laser, whether it's for hair removal or birthmark or scars or wrinkles, any of that stuff?
Speaker 2:So when a patient calls our clinic, they will first be scheduled for a consult visit where we will discuss their concerns, their goals and decide upon the most appropriate treatment plan for them.
Speaker 2:When they come for their laser appointment, they will be taken first for baseline photographs photographs Depending on the type of laser treatment that they're undergoing that day. Topical numbing cream may be applied to the skin for anywhere from 30 to 45 minutes. Next, the patient's skin is cleansed and sterilized, and then the laser treatment itself can last from anywhere from several minutes to maybe an hour or more, depending on the type of laser that's being used and the surface area that's being treated. Once the laser treatment is completed, we typically apply petrolatum or another post-procedure healing balm to the treated area, and then the patient is able to go home, and usually everyone is able to drive themselves home after the procedure able to drive themselves home after the procedure and are there, like, any steps that a pre-laser patient needs to take, like I have a lot of patients on blood thinners, anticoagulants, just different immune suppressive medications for transplant?
Speaker 2:Yeah, we typically are not stopping a patient's medical regimen prior to laser treatment just because the benefit of being on those treatments typically outweighs the cost of getting the laser treatment. While being on them, we don't want to stop something that's medically necessary, but we do have some steps that we ask patients to take to prepare for their treatment. Depending on the type of treatment and the patient's skin, there could be several steps involved. So for all patients undergoing laser treatment, it's important that they are not sunburned or tanned, and this includes a natural tan or self tanner prior to the treatment. A lot of the lasers can cross, react with pigment in the skin and then give an adverse outcome. Or if the skin has already been damaged or is sensitive from the sun exposure, and then the laser can cause unwanted irritation.
Speaker 2:For patients with conditions like melasma or other pigmentation concerns, I like to prime their skin first with a topical skin brightener for anywhere from one to three months. This helps calm down pigment-producing cells, which increases the efficacy of the treatment and also minimizes the risk of worsening their pigmentation. It also helps fade that pigmentation so that ultimately, fewer laser treatments are required. For patients undergoing laser resurfacing to help with reversing facial aging, I like prescribing a topical retinoid prior to treatment. Retinoids increase skin cell turnover. They also help boost collagen production in the skin, and this makes the laser treatments more effective when we've improved the quality and the health of the skin prior to treatment. Patients also might be required to start certain prophylactic medications, including antibiotics and antivirals, prior to undergoing facial laser resurfacing, and we recommend that all patients hold the retinoid one week prior to the laser treatment to minimize the risk of skin irritation.
Speaker 1:Wow, those are all very important health tips and information. Going back to using lasers for hirsutism, is it true that there needs to be a contrast between the color of the hair and the skin to get a good effect?
Speaker 2:the color of the hair and the skin to get a good effect. Yes, so this is something that causes a lot of confusion amongst patients. When we use a laser for laser hair removal, the laser is not targeting the hair itself. The laser is targeting things that are dark. So we are relying on the laser differentiating between the color of the hair and the color of the surrounding skin. When we fire one of these lasers at the hair, the hair will absorb the laser energy and it will heat the hair up all the way down to the base of the follicle and destroy it. That follicle then is dead and will fall out sometime within the next couple weeks.
Speaker 2:Of course, our hair has various cycles of growth and our hairs are in different phases of growth. You know different amounts of the hair are in different phases of growth at any given time, so the laser is not able to target every hair at once. That's why these treatments require multiple sessions. We want to hit that new cycle of hairs every time it grows in. We do these treatments at about six to eight week intervals, and if we can be consistent with this, patients tend to get a better result and faster clearance of the hair. On average, I would say it takes about six to eight treatments to get good clearance.
Speaker 1:Wow, six to eight treatments. And so when patients get that consultation, do they get the information about the financial cost at that time?
Speaker 2:Yes, yes, so that's something we go over, depending on what the patient is looking to treat. I talk to them about options of submitting through insurance versus paying out of pocket. As we previously discussed, very few laser treatments are covered by insurance, but hirsutism is typically covered by insurance and for patients who are on the Cleveland Clinic employee health plan, it is something that is covered by the insurance.
Speaker 1:That's really good to know. Now about the hirsutism. So a light-skinned person would want to get their laser done before their hair turns gray or white. Is that right?
Speaker 2:Yes, that is correct. So currently the lasers we have can only target hair that is brown or black. We are unable to target any hair that is white, gray, blonde or red. For patients with hair of those colors that are looking to undergo hair removal, we recommend that patients have electrolysis. And if you have dark skin, you can still target the dark hair.
Speaker 1:Yes, we do have lasers that are safe for skin of color, but again, we want to make sure patients are not having any sun exposure or doing anything that's going to darken their skin and make it difficult for the laser to distinguish between the skin and the hair and the other thing I deal with a lot is melasma, and you know what I tell women is, once they've gone through, whatever their treatment is, whether it's topical or laser that they always need to protect against the sun, solar exposure, or it will come back. Do you endorse that?
Speaker 2:Oh, absolutely Diligent. Sun protection and daily SPF use is the cornerstone of melasma treatment. We recommend that patients use a sunscreen that is at least SPF 30 or higher, one that is a physical sunscreen, so that's ingredients like zinc oxide, titanium dioxide and iron oxide. Those are more effective at blocking UV rays compared to chemical sunscreens. And I also tell patients to choose a sunscreen that has a tint. This tint will help block visible light that's like our colors of the rainbow. So that includes things like blue light that are coming off of screens and devices that we're using, because all of those things can worsen melasma. There's even evidence to suggest that some melasma is worsened by heat alone, and you don't even necessarily have to have sun exposure for it to get worse. So if it's very hot out, or I've even had patients who spend a lot of time over the holidays cooking in front of the stove and they tell me that they feel like their melasma has flared just from that.
Speaker 1:Oh wow, I didn't know that about the heat. I had melasma with my first pregnancy and a physician looked at me and said rub that dirt off your forehead. And so I use the topicals and like I don't even go out and get the mail without my hat on, or I've even water skied with, you know, with a visor, like no sun, but I never thought about cooking over a hot stove. I guess now I have a reason not to cook over a hot stove yeah, it's a.
Speaker 2:It's a little more rare, but definitely sun protection is very important. You know, I tell patients if you're not going to protect yourself with sunscreen and shade and hats, like there's no point even treating, and I tell patients because you're never going to make any headway, I tell them the same thing.
Speaker 1:Now are you using compounded transdynamic acid? We use, like transdynamic acid, lysedata orally to treat heavy bleeding.
Speaker 2:Yeah, so depending on how severe it is and after having a discussion with a patient, we could do one of several options. Some patients are on oral tran-examic acid. We have to make sure that it's safe for them to do it, because there are some contraindications to this. For patients who are not a candidate for that or whose melasma is not so severe, we do use compounded topical creams. Tranexamic acid could be one of these ingredients. There are also many other ingredients like trinoin, kojic acid, hydroquinone, so I find that these compounded creams tend to be much more effective than any other ingredient used in isolation.
Speaker 1:And I would imagine most of that is self-pay as well.
Speaker 2:Yes, a lot of the topical creams are self-pay, but there's a lot of really great compounding pharmacies out there these days that are selling these medications for an extremely affordable price. The one that I prefer to use sells most of these creams for about $45. Wow.
Speaker 1:Well, this has been such great information. We'll have to bring you back another time because we didn't get to talk about injectables and Botox and if it's safe or not, because I know so many women are doing it and they ask me all these questions about it. But I am not I'm not a cosmetic dermatologist. I don't have those answers, but I certainly like to get them for our audience. If any of our listeners are interested in making an appointment in Cleveland with Dr Taryn Murray, you can call 216-444-4004. And we'll put that in the show notes. And I understand you have an Instagram channel. Do you want to tell us your handle, doctor?
Speaker 2:Yes, it is TarynMurrayMD. It's T-A-R-Y-N-M-U-R-R-A-Y-M-D.
Speaker 1:And is there anything else that, any other words of wisdom you want to impart to our listeners?
Speaker 2:I would say for anyone considering laser treatment, it's not just an in-office treatment that's going to give you the results you're looking for. It's really lifestyle how you're taking care of your skin, your overall health, and then these in-office treatments that are really going to give you an optimal result. So I encourage any patients that are interested to come in for an evaluation and we can talk through all of these components to an effective skincare regimen.
Speaker 1:And what about for our listeners? Because we're like in 80 countries that won't have the ability to come to Cleveland, 80 countries that won't have the ability to come to Cleveland. Is there any like resources or ways that you can check to find out if your dermatologist has the specialized training with lasers and the leading edge cosmetic treatments, if you're going to spend the time and the money and undergo the risk for these therapies?
Speaker 2:So I believe, through the American Academy of Dermatology and possibly through the American Society for Dermatologic Surgery, you are able to check if a dermatologist is board certified and it should also say whether they have done a fellowship. But I also encourage patients. You know, don't be afraid to ask questions. If you're going to see someone for a treatment, don't be afraid to ask them what their credentials are. Don't be afraid to ask them how often they do these procedures. You know what their experience level is, what they do when there's an adverse event that occurs. You know, don't cut corners with your body. Don't be afraid to ask these questions. You want to make sure that you're in the best and safest hands.
Speaker 1:That is so important, and the same thing. We've seen disasters with plastic surgery. People go overseas for cheaper breast surgeries and butt lifts and liposuctions and all sorts of things that sometimes actually end up in death.
Speaker 2:So oh yeah, we've seen that as well. Wow, well, so unfortunate. We've seen that as well, wow.
Speaker 1:Well, so unfortunate. Thank you, dr Murray, for joining us on this Speaking of Women's Health podcast and thank you, our listeners, for tuning into another episode. We're so grateful for your support and we hope you will consider giving us a five-star rating or sharing it with your friends. And to catch all the latest from our podcast, simply subscribe or hit the follow button. It's free, anywhere you listen to podcasts, and we will be back again in the future for another episode of Speaking of Women's Health. Thank you again and we'll see you next time. Remember, be strong, be healthy and be in charge.
