Dr. Sarah Schram’s Adventure in KwaZulu-Natal, South Africa

IMG_6310IMG_6528IMG_6493Earlier this year, Sarah Schram, MD went on a spectacular adventure, traveling to KwaZulu-Natal, known amongst discerning travelers as the “must-see, must-do” destination in South Africa. She spent five wondrous days there – and not in the way you would expect. She was not a tourist in search of its pulsating energy and exotic wildlife. Instead, she showed up in scrubs as a teacher. In the unique splendor and natural beauty of KwaZulu-Natal, Dr. Schram lent her surgical skills to the University of Nelson R. Mandela School of Medicine. The University has a proud and opulent heritage of academic excellence.

The Medical School is dedicated to producing highly qualified and experienced medical practitioners devoted to improving the quality of life of South Africans. This is a program that has a very strong medical dermatology program but has not had surgery in the past. Historically, most everything is sent to plastic surgery, often creating extremely long waits and preventing treatment for patients in need. Dr. Schram instructed both their resident physicians and attending physicians in cutaneous surgery skills, including cancer excisions, suturing, benign lesion destruction and post-op wound care. Dr. Schram and a number of program physicians treated a variety of conditions including skin cancers, neurofibromas, keloid scars, dermatosis papulosa nigra (DPNs), and cysts for underprivileged patients.

Patients came from far and wide across the country, some even traveling for eight hours by bus for an opportunity to be seen and treated. Dr. Schram felt compelled to provide teaching and mentorship to a new group of up and coming doctors. “I was motivated to do this as I have been very fortunate in my career to have great teaching and mentorship. I wanted to be able to provide this to a new group of doctors.” In teaching them, she was also rewarded with some new medical dermatology peals as well. Traveling to South Africa didn’t go without some out-of-this-world sightings either. Outside of clinic, Dr. Schram took in some breathtaking views and met some new friends along the way.




By Maria Cano, CMLT, Aesthetician

Patients looking for a new treatment to refresh, revitalize, and enhance the appearance of their skin are ideal candidates for EndyMed’s 3DEEP® Intensif Micro Needling. It is the first FDA cleared collagen remodeling solution for fine lines, deep wrinkles, acne scars, large pores, and stretch marks. The Intensif technology delivers short consistent pulses of radio frequency energy (RF) through tiny microneedles that penetrate the skin. The heat targets the dermis, allowing for skin remodeling. It is designed to create “micro-wounds” where there is no epidermal damage. These small wounds trigger the skin to repair itself by producing new collagen.

The Micro Needling can be used anywhere on the face, neck and body. Benefits include tightening of the collagen fibers leading to smoother, firmer skin. It also helps to minimize pores, alleviate acne scars, correct stretch marks, soften lines around the mouth and eyes, reduce skin laxity, and increase collagen production. It can be used on all skin types and color, leaving visible improvement even after the first treatment.

Treatments are performed in our Cosmetic Department. For optimal results, patients should complete a series of 3-5 treatments, given every 4 weeks. Micro Needling can also work well with other complementary services. For up to 8 months after the last treatment, the treated skin will become smoother, tighter and more vital. As most of the energy is delivered directly into the inner layer of the skin, patients will experience minimal downtime and may resume normal activities immediately.


By Sarah E. Schram, MD / Mohs Surgeon, Cosmetic Dermatologist

There is new hope to those at high risk of developing the most common types of skin cancer and the key may be an over-the-counter vitamin supplement that costs less than $10 a month. Nicotinamide (a form of Vitamin B3) has been shown in recent studies to reduce the risk of both actinic keratoses (precancers) and non-melanoma skin cancers. Ultraviolet light causes damage to the DNA of our cells, necessitating repair that depletes cellular energy. Nicotinamide helps to replenish this energy, thus improving the rate of DNA repair and decreasing cellular immunosuppression. Taking nicotinamide 500mg by mouth twice daily led to a 35% reduction in actinic keratoses in one study (Surjana et al. 2012). Another study showed that in patients who have had at least two non-melanoma skin cancers in the last five years, there was a 23% reduction in development of new basal cell and squamous cell carcinoma compared to the placebo (Chen 2015).

While there is not enough data yet to suggest that all people should take nicotinamide, if you have a history of skin cancer, it may be helpful to decrease the risk of developing more.  Nicotinamide is contained in many foods such as beans, meat, fish, eggs, milk and cereals but to reasonably get to the doses reported in the study, a supplement would need to be used.  The dosing recommended by the study is 500mg twice daily.  At this dose, very few side effects were reported.

Surjana D, Halliday GM, Martin AJ, Moloney FJ, Damian DL. Oral Nicotinamide reduces actinic keratoses in phase II double-blinded randomized controlled trials.  J Invest Dermatol  2012;132: 1497-500.
Chen AC, Martin AJ, Choy B, et al. A phase 3 randomized trial of nicotinamide for skin cancer chemoprevention.   N Engl J Med 2015;373:1618-26.

Not Just “Lip Service”: Real Lip Rejuvenation

Gerald N. Goldberg, MD – Medical Director, C0-Owner, Pima Dermatology

“Smoker’s lines”, around the lips and mouth, are a common concern for many of us. They are the deep vertical lines above and below the lip margin, often caused by sun damaged skin and repeated muscle movement. These lines are accelerated and worsened by smoking and other “puckering” activities involving the mouth musculature, such as smoking and sipping with a straw.

Line remedies exist and there are some excellent treatment alternatives that can be tailored and customized to achieve significant cosmetic improvement. In looking for a natural, more healthy and youthful appearance, it is important to define your goals, budget, and what steps you are willing to take to achieve them. Do you want a one-time, fairly aggressive treatment, or a more modest, incremental, stepwise series of treatments to reach your aesthetic goals?

Minimal downtime treatments can be achieved in-office with injectable dermal fillers or a series of low downtime Laser treatments done monthly over a period of months. A wide-range of dermal fillers made from hyaluronic acid, a product identical to skin’s dermal makeup, are available. The latest offering is Volbella®, used to achieve a softening and smoothing of lip wrinkles and subtle volume, with minimal downtime and very natural-looking results. Dermal fillers can be injected safely and relatively comfortably. Side-effects can include some mild swelling after injection with the possibility of bruising lasting a few days. Price range is $450 – $500 per syringe and typically requires 1 to 2 syringes for desired correction.

Minimal downtime Laser treatments are usually performed by aesthetic staff under topical anesthesia or no anesthesia at all. Laser Skin Toning is performed with warm infrared light, and has the least downtime, with modest redness and swelling for a few days. This treatment is repeated at monthly or bimonthly intervals. Pricing is $195 – $495 per session.

A more intense Laser treatment can be done with a Fractional Erbium Laser, such as the StarLux® or the Sciton® Halo™. These devices are also employed by aesthetic staff under topical or no anesthesia, and are typically done in combination with full facial treatment, which involves a sunburn-like reaction and peeling for several days post treatment. These  sessions can also be focused solely around the mouth and repeated at intervals to achieve an optimal effect. A consultation will provide pricing based on areas treated, typically $600 – $1500 per treatment.

The most aggressive lip line remedy is with the ablative Lasers, such as the Sciton® Profractional™ or DOT® carbon dioxide Lasers. These Lasers are used in combination with topical anesthesia, mild sedation, and at times anesthetic blocks (like numbing at the dentist). Performed by physicians, these lasers can involve up to a week or more of healing time, but often achieve the most dramatic effects. Full Face Laser Skin Resurfacing ranges from $2100 and up. For lip lines only, the price is less and can be determined at your consultation.

For more information, please view our website at www.pimaderm.com or call to schedule a consultation at 520.795.7729.

Photo Credit: Gerald N. Goldberg, MD