Half of Breast Cancer Patients Experience Severe Side Effects

Study finds side effects cause extra burden for patients, health care system

Newswise, February 3, 2017— Nearly half of women treated for early stage breast cancer reported at least one side effect from their treatment that was severe or very severe, a new study finds.

While it might be expected for women undergoing chemotherapy, researchers found one-third of women who didn’t receive chemotherapy experienced severe side effects of treatment.

Side effects led to additional doctor’s appointments, trips to the emergency room, delays in treatment and reduced dosages.

“It's in patients’ best interest to receive their treatments on time and on schedule, whenever possible, to give them the best possible outcome. Unscheduled care for toxicities – including clinic visits, emergency department visits and hospital stays – are expensive, inconvenient and disruptive to both doctors and patients. We need to avoid them whenever possible,” says study author Steven J. Katz, M.D., MPH, professor of medicine and of health management and policy at the University of Michigan.

Researchers surveyed a diverse group of 1,945 women diagnosed with early stage breast cancer. Women were surveyed an average of seven months after diagnosis.

They were asked to rate the severity of seven common side effects of breast cancer treatment: nausea/vomiting, diarrhea, constipation, pain, arm swelling, shortness of breath and breast skin irritation.

The survey also asked patients what kind of help they sought for their side effects – from discussing it at a routine visit to scheduling additional appointments or seeking emergency care. The study is published in Cancer.

Overall, 93 percent of women said they experienced at least one of the seven side effects, with 45 percent rating it severe or very severe. Pain, skin irritation and constipation were most frequently severe or very severe.

Most patients sought help for side effects during routine doctor’s appointments, but 9 percent scheduled an additional appointment and 5 percent went to an emergency department or hospital.

Women who had both chemotherapy and radiation treatment were 30 percent more likely to report a severe side effect, compared to women who had only one of those treatments.

Women who had double mastectomy were twice as likely as those who had lumpectomy to report severe or very severe pain. Severe side effects were also more common to Latina women, who were 30 percent more likely than white women to report a severe or very severe side effect.

For the most part, side effects of cancer treatment are reported via clinical trials or cancer registries. Few studies have solicited input directly from a diverse group of patients.

“As an oncologist, I knew from my clinical practice that more women were suffering than is generally reported in clinical trials,” says Allison Kurian, M.D., M.Sc., associate professor of medicine and of health research and policy at Stanford University.

“Often, women suffer in silence, afraid to tell their providers about how bad things really are for fear that their treatments may be halted. We need to change that.”

She says it’s important for oncologists to share information about potential side effects with patients. By making patients aware, they can prepare what to do if nausea, constipation, pain or other side effects occur.

In addition, better data on the severity of side effects should be collected and then shared with patients to help with their treatment decision-making.

The researchers are developing tools to help women understand how side effects vary by treatment. Additional studies are examining how side effects vary across diverse chemotherapy practices, as well as the optimal way to manage side effects.

Additional authors: Christopher R. Friese, Ph.D.; Jordan M. Harrison, BSN; Nancy K. Janz, Ph.D.; Reshma Jagsi, M.D., D.Phil.; Monica Morrow, M.D.; Yun Li, Ph.D.; Ann S. Hamilton, Ph.D.; Kevin C. Ward, Ph.D.; Timothy P. Hofer, M.D.

Keeping the Beat – Addressing the Health Challenges of Heart Disease

Newswise, January 14, 2017 — Researchers at the UCLA School of Nursing are addressing health challenges related to issues of the heart, the leading cause of death worldwide – from chronic health concerns faced by individuals born with congenital heart disease to those who are at risk or have developed cardiovascular disease.

For each researcher, there was a defining moment that started them on their research path. Maybe it was a specific patient or being at the right place at the right time.

For some, the path has been fairly straight, while others have had twists and turns. But all of their journeys are changing lives of patients and moving science and nursing practice forward.

The difference these researchers are making shows why the UCLA School of Nursing is a leader in cardiovascular health.

From the Moment of Birth – identifying and addressing the effects of Congenital Heart Disease

Congenital heart disease is the No. 1 birth defect in the nation. Forty years ago, most children with congenital heart disease did not survive into adulthood. But with the advent of new surgical procedures, postoperative management and follow-up care, these children are surviving.

As a result, issues related to their health have unfolded, leading to two researchers – Mary Canobbio and Nancy Pike — to look for answers to improving health outcomes and quality of life.

Shortly after Canobbio earned her master’s in nursing from UCLA, she was offered a chance to participate in the development of a new program managing patients born with congenital heart disease (CHD) but now as adults would need continued, life-long care. At the time there were no CHD programs that transitioned patients from pediatrics to adult-centered care.

Thus, the UCLA adult congenital heart disease (ACHD) program became the first program of its kind in the U.S. Today there are more adults with CHD than children, but the number of centers available to care for them remains limited.

As the program’s Clinical Specialist , Mary found that many of the women had menstrual problems and those with complex heart problems were told they couldn’t get pregnant.

But nobody had the answer as to why. “I kept saying – we need to find the answer and finally one physician said, ‘Mary you should do a study.’ So I did the first menstrual study on women with congenital heart disease. And that was the beginning.”

The advent of a new procedure in the late 1980s – Fontan – offered new hope for one population who had been told they could never get pregnant.

“Now the question became not could they get pregnant, but should they get pregnant?” And once again Mary was on a mission. Ultimately she worked on two studies with the Mayo Clinic in the 1990s to find if women’s menstrual cycles returned to normal and if so, could they safely get pregnant. She has kept a multi-centered registry since that time and has recorded 100 pregnancies and 72 live birth.

 “While it may not seem like a lot, it is the most reported in the literature.”

There are still questions regarding the health risks for these women – does the pregnancy put additional strain on the woman’s heart and potentially shorten her lifespan? Canobbio has followed women in the registry and hopes to publish her study focused on the long-term effects of pregnancy in these patients with complex CHD.

Cannobio’s work has not gone unnoticed by heart experts. Nearly 20 years after she started working with adults born with CHD, the AHA published a best practices statement on the transition of care and will soon be publishing a Scientific Statement on the reproductive issues and Mary’s studies are key.

Nancy Pike had worked for more than two decades as a nurse practitioner in pediatric cardiac surgery. Children born with only one pumping chamber in their heart – known as single ventricle congenital heart disease – often need to have two or three surgeries before they are three, which researchers believed could affect cognitive development.

Pike was also hearing anecdotally from parents that, as the children grew, many of them were having difficulties remembering things, struggling more often in school and had to work twice as hard to get good grades compared to their siblings who were not born with heart problems.

Pike found that there had been little research specifically linking memory loss and brain structure injury in this population.

 Her pilot study looking at memory identified approximately 60% of teenagers with CHD had mild memory deficits and demonstrated worse verbal verses visual memory compared with healthy controls.

From that study, she decided to do her own research and, with a grant from the National Institutes of Health (NIH), Pike set about studying memory and brain structure injury in adolescents with single ventricle heart disease. Her study has found structural injury in areas of the brain that support memory and cognitive function. The key now is to find out why this occurs and whether we can help them – is this injury permanent?

In a new, pilot study, she is collecting data to see if these adolescents might be thiamine deficient “which is often seen in adult heart failure patients because of chronic diuretic use.”

Along the way, Nancy’s research was adopted by students at Flintridge Sacred Heart Academy as a community service project. After she had tested a student at the school who had single ventricle heart disease, she needed healthy controls.

The student’s classmates quickly stepped up to participate and the project ended up as a two-page feature story in the school newspaper.

Pike is just completing the research on this first grant and has now received a second NIH grant to look at cerebral artery integrity and the link to brain injury and cognition in CHD.

The exact cause of brain injury in some patients with CHD is unknown. Compromised integrity of the cerebral arteries may contribute to reduced cerebral blood flow and cause brain injury of neural tissue.

In the long run, she hopes that her research will translate to the bedside in how clinicians care for these children both before and after cardiac surgery to reduce the risk of brain injury

Addressing the #1 Cause of Death

Who can be affected by cardiovascular disease? Everyone. It is the leading cause of death for both men and women and it can affect people of all ages, races and ethnicities. Researchers at the school are looking at various aspects of cardiovascular health – from identifying risk factors and prevention, to correlation between heart failure and brain function and outcomes of heart transplantation. All of this work is aimed at getting patients on a better health path.

Mary Woo is passionate about her research. She will tell you that “despite all the advances in treatment that have emerged in the last 10 to 15 years, the high rates of mortality and morbidity in heart failure haven’t changed.

And that situation isn’t going to improve until clinical practice starts to address the compounding factors that are contributing to that morbidity and mortality—namely, the considerable amount of brain damage we’re seeing in these patients.”

Woo worked as a staff nurse in cardiac critical care for 13 years. “As a night shift nurse, I could tell who was going to die by listening to the way patients were breathing while they slept — that it was an indication that something was wrong.”

This led her to examine heart rate variability as an independent predictor of sudden cardiac death risk in advanced heart failure patients. As a result of this research, Dr. Woo developed one of the first heart rate variability assessment techniques to be an independent predictor of sudden death risk in advanced heart failure patients.

She then expanded her research to examine predictors of sudden death risk as well as the influences of sleep on brain structure in heart failure. She was the first investigator to report that the specific sites of gray matter loss in heart failure patients are impacted by the amount of sleep disordered breathing as well as gender.

Her groundbreaking studies have shown that heart failure patients have significant brain damage in areas that dramatically impact cognition, emotion, and breathing.

By developing interventions that minimize or reverse the brain damage in heart failure, Dr. Woo aims to improve health outcomes for heart failure patients and “hopefully someday save lives.”

Since 1997, Woo has been continuously funded for her research by the NIH. In addition to numerous presentations and publications, she was recognized as a “Pillar of Cardiovascular Nursing Research” by the American Heart Association (AHA) Council on Cardiovascular Nursing.

Lynn Doering was a master’s student in nursing and working as a cardio-thoracic ICU nurse when she had an innovative idea. Could we get the same readings if patients with catheters were positioned on their side as on their back (which was the standard at the time)?

She published the results of her study, which wet her whistle for nursing research and led her to pursue her PhD. Her doctoral dissertation was on heart transplant patients.

At the time, it was believed that the transplanted heart was “de-innervated” or had lost the nerve stimulation which affected the heart rate. “We wondered over the long term if the innervation returned and found that people who were a year out from their heart transplant had some heart rate return,” said Doering.

This became the first study that showed that the nerves in these patients grew to send heart rate signals to their brains.

Unlike her colleagues who were focused on studying various aspects of heart failure, Doering continued to have an interest in following patients after heart surgery.

In a patient satisfaction study, she received revealing responses to the question: “What would you like your doctors and nurses to know?” With Dr. Anthony McGuire, a master’s student at the time, she published a paper, “Recovering from cardiac surgery: What patients want you to know,” in the American Journal of Critical Care in 2002, that was one of the most highly read papers in nursing literature for years.

With guidance from former Dean Marie Cowan, Doering began studying depression – first in heart surgery patients and now in all cardiovascular patients.

She has studied the use of nurse-delivered cognitive behavioral therapy (CBT) – a present-focused, problem-solving form of psychotherapy – to reduce depressive symptoms and immune-mediated postoperative inflammation after cardiac surgery.

Currently she is piloting the use of quantitative electroencephalograms (QEEG) to provide early prediction of response to CBT in cardiovascular patients with depressive symptoms, so that depression treatment can be personalized.

She has also come full circle in her research trajectory by returning to the heart transplant population. She is completing a study to test wireless ECG monitoring as a means to predict early organ rejection after heart transplant.

One in three women in the United States is living with cardiovascular disease, including nearly half of all African American women. During her master’s program, Jo-Ann Eastwood saw that firsthand in her clinical practice as a critical care nurse.

“After many years of seeing women come in to our emergency department who were 55 and had already had a heart attack, I knew something had to shift. It was obvious that awareness and prevention of heart disease was not on their radar, although the risk factors were present. Many survived but lived with a less than optimum quality of life due to the damage that had been done to their hearts. That's what drew me to this population: Where could I do the most good?” said Eastwood.

She also came to realize that there was a lot of racial disparity – that black woman have a higher risk of heart attack and stroke – and at a much younger age. Partnering with several local African American churches, she conducted a study, funded by the American Heart Association, to test the effectiveness of using education and connectivity through smartphone apps to help young black women reduce their risk for heart disease.

The app was developed in collaboration with the UCLA Wireless Health Institute. Women were sent daily and weekly questions and feedback and motivational messaging regarding their eating and exercise habits.

Each Sunday they measured their blood pressure using blue-tooth equipped pressure cuffs that sent readings to the researchers. All the data was collected and reviewed by the researchers, who in turn could coach the women if the researchers saw an unusual response.

Early results showed that the women had significant improvements in blood pressure and cholesterol levels. Even more exciting for Eastwood was that the women didn’t just improve their own cardiovascular health, but the health effects extended into the family, which for Eastwood was her biggest reward.

Eastwood’s study garnered a lot of external media coverage, including a front page story in the California section of the LA Times.

Sarah Choi is one of the newest faculty members at the School and her program of research focuses on cardiovascular risk reduction among people with type 2 diabetes.

As a Family Nurse Practitioner, she treated many patients with type 2 diabetes – one of the major risk factors for cardiovascular disease. Approximately two-thirds of people with Type 2 diabetes die of heart attack or stroke, not just from the high level of blood glucose.

She wanted her diabetic patients to realize that they were at higher risk of developing heart disease than their peers without diabetes and that they needed to make serious lifestyle behavior changes to control other risk factors such as high blood pressure and cholesterol.

Choi’s first study looked at whether patients make a connection between diabetes and heart disease. “If these patients didn’t see the link, then they are unlikely to make lifestyle changes that they need.”

She found that diabetic patients had a very low perception of their heart disease risk. In fact, many of them felt they were “protected” from heart disease by taking medications for diabetes.

“Risk perceptions can influence health behaviors,” said Choi. “Considering numerous study findings indicating that reducing dietary and lifestyle risk factors could prevent most cases of heart disease, stroke, and diabetes, helping diabetic patients understand their risk for heart disease can be the first step in desired behavior changes.”

Ovarian Cancer Survival Rates Improve in Sanford Study

Sanford Research lab exploring role of protein in disease progression

Newswise, January 3, 2017– A Sanford Research lab is studying a protein’s role in improving survival in ovarian cancer patients. Findings published in Oncogenesis indicate a higher level of a specific protein correlates with an increased survival rate and decrease in the spreading of cancer cells.

Kristi Egland, Ph.D., an associate scientist in the Cancer Biology Research Center at Sanford Research, led the study, which retroactively looked at tumor samples from ovarian cancer patients. 

Her team noticed that patients with higher levels of the Sushi Domain Containing 2 protein, or SUSD2, experienced less metastasizing of cancer cells and thus survived an average of 18 months longer.

“We want to better understand how SUSD2 played a role in inhibiting the spread of cancer from the ovaries to other parts of the body,” said Egland. “Ovarian cancer is usually diagnosed in late stages and after it has spread, which makes it difficult to cure. The mechanisms that underlie SUSD2’s ability to reduce metastasizing of cancer cells could help us identify drugs that mimic its function and provide a target for therapy options that prolong survival.”

SUSD2 is a protein common in cancers that is responsible for telling cells where to attach to other cells. In ovarian cancer, cancer cells often attach to the lining of the abdominal cavity and spread to other organs in or adjacent to that area. Higher levels of SUSD2, according to Egland, seemed to stop the attachment of cancer cells to other organs.

The American Cancer Society reports that ovarian cancer accounts for more deaths than any other cancer of the female reproductive system and ranks fifth in cancer deaths among women. A woman's risk of getting ovarian cancer during her lifetime is about 1 in 75, and her lifetime chance of dying from ovarian cancer is about 1 in 100.

Egland’s lab at Sanford Research specializes in studying proteins for use as diagnostic markers and immunotherapy targets. In addition to exploring ovarian cancer, her lab also does work with breast cancer.

Oncogenesis is a peer-reviewed online journal focusing on the molecular basis of cancer and promoting diverse and integrated areas of molecular biology, cell biology, oncology and genetics.

About Sanford Research

Sanford Research is a non-profit research organization and is part of Sanford Health, an integrated health system headquartered in the Dakotas. Sanford Health is one of the largest health systems in the nation with a presence in nine states and four countries. 

More than $600 million in gifts from Denny Sanford has provided for an expansion of research initiatives in type 1 diabetes, breast cancer and genomics in internal medicine.

With a team of more than 200 researchers, Sanford Research comprises several research centers, including Children’s Health Research, Edith Sanford Breast Center, Cancer Biology, Center for Health Outcomes and Population and Sanford Sports Science Institute.

Act Your Age When It Comes To Skin Care

 Dermatologists share tips for women 

Newswise, November 15, 2016— People experience many changes as they age, and that includes changes in their skin. The body’s largest organ evolves over time, so it’s important for one’s skin care routine to evolve with it.

Although dermatologists’ skin care recommendations for each patient will depend on that patient’s age, there are a few core steps dermatologists advise virtually every woman to take:

1. Select products tailored to your skin type — for example, special formulations for sensitive skin, moisturizing products for dry skin, and oil-free or noncomedogenic options for oily skin.

2. Protect your skin from exposure to ultraviolet radiation from the sun and indoor tanning beds, which can lead to skin cancer and early skin aging. The American Academy of Dermatology recommends that you shield yourself from the sun’s harmful UV rays by seeking shade, wearing protective clothing and using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.

3. Use a retinoid, unless it dries out or irritates your skin. Retinoids increase cell turnover to exfoliate clogged pores and reduce the appearance of fine lines, which means they can effectively treat both acne and wrinkles.

While these steps form the foundation of most skin care regimens, each individual’s skin care routine should be based on her age and her skin’s specific needs. To kick off National Healthy Skin Month, three board-certified dermatologists discuss the top skin care concerns of women in their 20s, 30s and 40s, and provide skin care tips for each age group.

Women in their 30s: At the crossroads of prevention and treatment

Dark spots
When women in their 30s come into her Augusta, Ga., private practice to seek treatment for dark spots, board-certified dermatologist Lauren Eckert Ploch, MD, MEd, FAAD, always provides them with tips for prevention. “If you have dark spots at this point in your life, you’re at risk for getting more as you grow older,” she says.

Because UV exposure causes dark spots, Dr. Ploch reminds her patients in their 30s about the importance of sun protection. When applying their SPF 30 sunscreen each morning, she says, it’s vital for women in this age group to make sure they cover their neck and chest in addition to their face, especially if they commute.

“Because UVA rays can travel through window glass, you need to make sure you’re protected if you’re spending a lot of time in the car or on a train,” she says.

Women who received unprotected UV exposure when they were younger may start to see dark spots on their temples and cheeks when they reach their 30s, Dr. Ploch says, and these spots may be mistaken for melasma, a condition that causes brown patches to appear on the face.

While lightening agents like hydroquinone are a good option for melasma, she says, they usually aren’t effective in treating dark spots.

Instead, Dr. Ploch recommends that patients with dark spots follow a multipronged treatment plan. In addition to sun protection, she says, topical vitamin C and retinoids may be used for both treatment and prevention.

 Laser surgery and cryosurgery are also options for reducing the appearance of dark spots, she says, but these procedures should only be performed by a dermatologist or another experienced medical professional.

Wrinkles
Dr. Ploch estimates that about half of her patients in their 30s are dealing with both wrinkles and acne.

As a result, she says, many patients in this age group may not be able tolerate wrinkle treatments designed for more mature skin because these heavier formulas can aggravate acne or cause milia, small cysts that occur when dead skin cells become trapped at the surface of the skin.

Dr. Ploch recommends women in their 30s use a retinoid to address both wrinkles and acne.

“Retinoids are my go-to wrinkle treatment for women in this age group,” she says. “In addition to improving your skin’s current appearance, they also help build collagen, which can lead to more voluminous skin in your 40s and 50s.”

Dr. Ploch also suggests that women in their 30s use a light antioxidant serum to protect their skin from the elements and improve signs of early skin aging, and she says those who are concerned about wrinkles also may want to consider botulinum toxin and hyaluronic acid fillers.

A low dose of botulinum toxin can minimize muscle movements that lead to future wrinkles, she says, and hyaluronic acid fillers can restore volume loss, reducing the appearance of lines around the mouth.

Spider veins
While spider veins are one of the most common problems for women in their 30s, Dr. Ploch says, they’re also one of the least-addressed problems in this age group.

Many women believe that treatment would be too invasive or expensive, she says, so they leave the condition unaddressed, allowing it to get worse as they get older.

According to Dr. Ploch, however, laser surgery and sclerotherapy are two accessible and noninvasive treatment options that women in their 30s may want to consider if they have spider veins. She also suggests that women in this age group take preventive measures against the emergence and progression of this condition.

Pregnancy and frequent standing are two risk factors for spider veins, Dr. Ploch says, and the condition takes several years to develop, which is why it often appears in women when they reach their 30s.

To help relieve the pressure that causes spider veins, she recommends that women wear compression socks, elevate their legs when possible and exercise, especially if they work in a field that requires prolonged standing, like health care or education.

Women in their 40s: Improvement through noninvasive interventions

Skin laxity
As people age, their skin begins to lose collagen and elastin, making it thinner and looser, without the resilient, springy quality of youthful skin, says board-certified dermatologist Anne M. Chapas, MD, FAAD, a clinical instructor of dermatology at Mount Sinai Medical Center in New York.

Skin laxity is most prevalent on the face and neck, she says, but it can occur anywhere on the body, including the arms, abdomen and thighs.

Everyone will experience some amount of skin laxity as they get older, Dr. Chapas says, but the degree of laxity depends on many factors, including sun damage, exposure to pollution, diet, weight fluctuations and lifestyle factors such as smoking.

“Women likely will start to notice skin laxity in their 40s, but they may not want to undergo an invasive procedure to correct it,” she says. “Fortunately, there are noninvasive options ideally suited for women in this situation.”

According to Dr. Chapas, energy-based treatments such as microfocused ultrasound and radiofrequency microneedling can help improve skin laxity by promoting the production of collagen and elastin to create firmer skin.

 “Imagine wrapping your loose skin in shrink wrap to pull everything tighter — that’s the kind of effect these energy devices can have,” she says.

Dr. Chapas says filler injections also can improve skin laxity by replacing lost collagen and elastin. “If you picture your skin as a tablecloth, then you can think of fillers as a sturdier table for it to rest on,” she says.

Volume changes
In addition to losing collagen and elastin as they age, Dr. Chapas says, women also lose fat in areas like the face and hands, resulting in a loss of skin volume. As a result, she says, women in their 40s may experience sagging skin, as well as prominent bones and veins.

According to Dr. Chapas, noninvasive treatments with dermal fillers and energy devices can help restore lost volume in addition to improving skin laxity. These treatments also may be combined to provide the best possible results, she says.

In addition to seeking treatment for lost collagen, Dr. Chapas also recommends that women in their 40s take steps to preserve the collagen they still have.

“It’s important to continue protecting your skin from the sun and the elements as you age,” she says, “and you also should consider incorporating topical growth factors and peptides into your skin care routine.”

Unwanted fat
Women in their 40s may have unwanted body bulges as the result of a slowing metabolism, pregnancy or other lifestyle changes, Dr. Chapas says. Even if women exercise regularly and are otherwise fit, she says, it may be difficult for them to eliminate fat in areas where the body is designed to store it, including the torso and the legs.

According to Dr. Chapas, women in their 40s who have isolated pockets of fat are ideal candidates for noninvasive body sculpting procedures like focused ultrasound, thermal energy treatment and cryolipolysis, all of which create areas of damaged fat that the body gradually removes.

While these treatments can be performed anywhere on the body, the waistline and thighs are the most commonly treated areas, Dr. Chapas says, while the neck and bra spillover area are currently gaining popularity.

Dr. Chapas says interest in these body sculpting treatments has surged in recent years because the procedures are noninvasive, quick and effective, with little downtime for patients.

Although liposuction remains the gold standard for fat removal, she says, other body sculpting procedures can provide subtle results for women who want to address problem areas without undergoing an invasive procedure.

No matter your age or skin concern, a board-certified dermatologist can answer your questions about skin health and help you develop a skin care plan that’s right for you.

In their own words: Dermatologists share their skin care secrets
Dr. Nada Elbuluk
“I wash my face twice a day with a mild cleanser and use a morning moisturizer with SPF 30 or higher. If I’m having an acne breakout, I use an acne spot treatment, typically with benzoyl peroxide and clindamycin. I also avoid the urge to pick or squeeze at any acne, as I know this will cause more inflammation and subsequent scarring. In the evening after cleansing, I use an eye cream and facial cream with retinol and antioxidants. During the day, if I know I will be outside for extended periods, I carry sunscreen in my bag so I can reapply. I also keep an eye out for any new growths or changes I see on my skin. Following these guidelines has helped my skin stay healthy, acne free, skin cancer free, youthful and radiant.”

Dr. Lauren Ploch
“Each morning, I apply an antioxidant serum that contains vitamin C. I follow this with a zinc oxide-containing sunscreen. I apply a retinoid product three to four nights per week, which is as often as I can tolerate it without irritation. I attribute my even, acne-free complexion to my retinoid — it’s the one skin care product I could not go without.

“I have treated my dark spots with various lasers and found them to be very effective as long as I protect myself from the sun after treatment. For wrinkles, botulinum toxin has ensured that I don’t have any! I started getting the occasional botulinum toxin injection in my mid 20s but began regularly injecting myself every four to six months in my early 30s. I prefer injecting smaller doses over the span of a few weeks to ensure that I always retain some natural expression. I also had a hyaluronic acid filler treatment last year and plan to follow up with additional treatments as necessary to restore volume lost over the past decade.

“Because I work long hours on my feet, compression socks are a must. I also wear them when traveling long distances, as sitting on a plane can lead to swelling and increased pressure in the legs. I prefer laser therapy to sclerotherapy for my small spider veins, and I elevate my legs at rest whenever possible to prevent their recurrence.”

Dr. Anne Chapas
“I’ve had noninvasive radiofrequency tightening treatments and dermal fillers regularly over the last few years. I also really like laser resurfacing, which removes damaged skin cells and replaces them with new ones. I think that smaller, regular, preventive in-office treatments, in addition to sun protection and topical retinoid use, have helped to maintain my youthful, healthier looking skin.

“Patients always comment on how ‘natural’ I look after I explain the treatments that I’ve personally received. I think it serves as an example that aesthetic treatments should look natural and healthy, not like you’ve had a lot of ‘work done.’ As dermatologists, we are experts in what healthy skin should look like and are the best-trained physicians to help patients to achieve this goal.”