Dr. Johnny Rash wakes up at 7am to start his daily regimen. His wife rolls her eyes at his various cleansers, self-tanning cream, toner, night cream, anti-wrinkle cream, lip balm with SPF, moisturizer with SPF 20, and daily hydration cream with SPF 15. By the end of his regimen, he is wearing SPF 210. He looks like he's just taken a bath in a tub full of Vaseline.
"How much sun coverage do you need?" his wife asks. "You're going to be inside all day and it's cloudy."
Sunscreen works by preventing light from the sun from penetrating deep layers of the skin. Sunblock causes light to scatter, so it doesn't reach the skin. Generally, sunscreen has sunblock ingredients in it. SPF, or Sun Protection Factor, indicates how long you can stay in the sun without getting a burn. For instance, a sunscreen with SPF 15 means you can stay in the sun for 150 minutes without getting burnt. Multiply the SPF by 10 to figure out how long the sunscreen will protect you from the sun. Or, if you're a redhead, divide by 20.
"You can get overexposure from walking across a parking lot or sitting under a window. Trust me. I spend all day removing cancerous skin off of people."
Upon arriving at work, Dr. Rash parks his car in the covered parking structure that is connected to his office building, then races through the lobby muttering, "There are too many windows in here." Okay, Dr. Rash is a little nuts.
His nurse greets him at the door of his office.
"I'm not going in until all the blinds have been drawn."
"They've already been drawn, and those people are coming in to tint the windows later on today."
"If only that were enough," Dr. Rash says.
His first patient is squirming and trying not to itch his legs against the table.
"Dr. Rash—I think I contracted wrestler's herpes."
"Have you been wrestling high school students? You're 30 years old."
"Umm…no…but look at my rash. I noticed it yesterday while I was hiking."
Dr. Rash examines the blistery rash on his patient's legs and flips open his prescription notebook. "You have two problems. First, you have an out-of-control WebMD addiction. Second, you have poison oak. Here is a prescription for Vistaril, which is a hydroxyzine cream. Don't ingest the cream, and keep it off your sensitive areas, like your eyeballs. Take Benadryl, because you are having an allergic reaction."
His patient sighs and mumbles a thank you. Dr. Rash writes in his notes hypochondriac with a red pen.
Dr. Rash's next patient is a middle-aged woman with a large bandage covering a third of her face.
"What do we have here?" Dr. Rash asks.
The woman starts to cry. "A huge zit. Why is this happening to me? I thought I was done with this stuff in my teens."
Adult acne is not rare; in fact, it actually affects 25% of men and 50% of women. According to Acne Organization, dermatologists are seeing more acne patients now than in previous decades. Causes of adult acne include cosmetics, hormones, stress and an increase of resistant bacteria. Acne, zits, pimples, and styes are all the same thing—infected sebaceous glands in the face. Sebum is oil that naturally drains out of the surface of the skin through a follicle or pore. When the surface of the skin gets blocked from an overproduction of cells, bacteria starts to grow inside the follicle. Ah, the glorious birth of a pimple. Popping a pimple can spread bacteria, which could create cystic acne. So don't listen to your big sister when she says all you need to do is squeeze it to death between a couple of pennies. She's always had it out for you, anyway.
To treat cystic acne, dermatologists must inject a diluted form of corticosteroid. If nothing happens in five days, a dermatologist may drain the cyst.
Dr. Rash gives his patient Isotretinoin to treat her cystic acne and tells her to take it twice a day. The medication reduces excess oil production. The added bonus is that this treatment will make her face less attractive to oil barons who are looking for new places to drill.
By noon, Dr. Rash is hungry. He contemplates running across the street to grab a sandwich. He takes one step outside, but thinks better of it. "Too dangerous," he thinks. He calls out for a pizza. Contrary to popular belief, greasy food doesn't cause acne, although diets that are rich in carbohydrates and dairy can increase blood sugar, which may in turn trigger acne. He gets his pizza without cheese. What a fun life Dr. Rash leads.
His last appointment of the day is a mole removal. His patien's mole looks like melanoma, which is why it must be removed and sent to a lab for a biopsy. Cancerous moles generally look asymmetrical, have ragged borders, turn brown or red, enlarge over time, bleed and itch. Leaving them alone can become life threatening, and they will not go away on their own. Dr. Rash injects his patient with an anesthetic and cuts out the mole using a surgical blade. He tells the man to expect a call in a couple of days if they find anything. His patient does not look relieved.
"In the meantime, use sunscreen, wear a light jacket, keep a hat on your head. This is the third mole we've removed from you this month. Did you know that one person dies from melanoma every minute of every day?"
His patient looks like he is going to faint. Dr. Rash sits down next to him. "I'm going to help you through the process either way. Okay?"
The patient looks no more relieved as he leaves.
Before Dr. Rash heads home for the day, he applies more sunscreen to his face and arms.
"It looks like rain, Dr. Rash," his nurse replies.
"Yep, you never can be too careful," he says, walking out the door.