Earlier 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.