The Bugs Are Out! How Can I Prevent Mosquito Bites?

Nothing gets people racing for cover quite like “the bugs are out.” Not only do mosquito bites cause itchiness and swelling, but they also put you at risk for mosquito-borne illnesses. These include malaria, West Nile virus, and Eastern equine encephalitis (aka “Triple E”).

Preventative Measures

Luckily, there are several ways to prevent mosquito bites. Preventative methods usually come in sprays, which contain DEET, Icaridin, and oil from lemon eucalyptus. DEET is the longest lasting repellent, and can be found in repellent brands such as OFF. When applying repellent, follow the “spray it, don’t say it” rule: keep your eyes and mouth shut.

Dress to protect. Wear long pants and long sleeves. Close-toed shoes are the best option, especially if you’re hiking, biking, or walking long distances. You may also want to wear a hat that covers your ears. Some hats even come with mosquito netting so you can cover your face.

Know where the vermin are setting up shop. Mosquitoes typically live in warm, damp environments with a lot of vegetation, such as swamps and marshes. If you’re going to be near those kinds of areas, make sure that you spray repellent generously every couple of hours. Mosquitoes tend to come out at dusk, so move things indoors when the sun starts to set.

If You’ve Already Been Bitten

If you’ve already been bitten, you may start to notice itchiness, swelling, and redness around the site of the mosquito bite. Most of these symptoms manifest the day after, and clear up within a few days. However, they can intervene with daily life, and some are severe enough to warrant a visit to the doctor.

Mosquito bites manifest most commonly in the form of an itchy bump that is hard to the touch. Apply a hydrocortisone ointment to the site to relieve itching and swelling. Calamine lotion for mild itchiness is also a good option. All of these are available as an OTC medication; you can find them at any pharmacy or supermarket. Other options for relief are cold compresses and OTC oral antihistamines such as cetirizine.  

Do not scratch or pick at the bite. This will only delay the healing process. Furthermore, it can lead to infection and scarring. If you think that this may be a problem, cover the site with liquid bandaid.


Mosquito bites. Mayo Clinic. Published October 22, 2015. Accessed June 13, 2017.


What Is In Sunscreen And What’s the Best Way to Use It?

My advice to all patients is to use sunscreen (SPF 50), which is available at most stores. Apply to the face, ears, back of the neck, hands, exposed legs, and feet. Reapply ever two hours, and immediately after sweating or water exposure.

It’s important to know the key ingredients in the sunscreen product itself, and how safe they are.

Zinc oxide and Titanium oxide are common ingredients found in many products. These micronized particles are for the most part safe, and don’t penetrate unbroken or undamaged skin. However, there are some concerns about these substances being absorbed into damaged areas. They should be avoided when the skin barrier is impaired. For example, if you have eczema or even a sunburn, don’t apply sunscreen directly to the wound site. Make sure you have an alternative method of protecting the site.

Products that contain benzophenone pose risks to the environment: they are harmful to coral reefs. They may also cause hormone complications: theoretical absorption may lead to estrogen-like effects, based on a rodent study. Benzophenone is most commonly found in organic sunscreens.

How you apply sunscreen has a direct effect on how well you are protected. While using sunscreen:

  • Apply generous amounts of sunscreen fifteen minutes before going outside. For optimal protection, apply your sunscreen before you get dressed.
  • It’s important to reapply every two hours, and to do so immediately after swimming or excessive sweating, even if the bottle promises water resistance.
  • Just because it’s cloudy doesn’t mean you don’t have to sunscreen. Clouds don’t protect you from damage, as UV light passes through them. Apply sunscreen as you would if it were sunny.
  • Keep in mind that sand, water, and snow are reflective surfaces.

The sunscreen product itself doesn’t protect you from serious complications such as heat stroke and dehydration. Don’t stay in the direct sunlight for too long, drink plenty of fluids, and reapply.

Onycholysis: What Causes It and How Can It Be Treated?

I often see women with onycholysis, or peeling of the nails. I feel like they don’t buy into my standard explanation, which is that the most common cause is mild chronic trauma to the nails. Most seem to want a miracle lotion, or a prescription for anti-fungal medication, but this isn’t always the correct form of treatment.

Onycholysis occurs in the fingernails and toenails, when the nail plate begins to peel away from the nail bed. It’s characterized by a white sheen over the nail, which is the nail plate separating from the nail bed. In the fingernails, the cause is most often trauma from manicuring, picking, and occupational injuries. In the toenails, the most frequent source is pressure and friction from walking in close-toed shoes.

Most onycholysis patients are women, and the most common cause is irritation. As mentioned before, excessive nail filing and overexposure to chemicals in manicuring products can irritate the area and cause breakage. Sometimes, a patient can even have an allergic contact dermatitis reaction to the adhesives in acrylic nails. In rare cases, onycholysis indicates iron deficiency anemia or an overactive thyroid.

To treat onycholysis, clip off the unattached parts of the nail. Keep your fingers away from water unless absolutely necessary. Use gloves when cleaning dirty surfaces, so that bacteria can’t get underneath your nails. Gloves also prevent mechanical injuries. Some even suggest using a hair dryer to blow your fingers dry, or just letting your hands air dry. Make sure you don’t cover or bandage the nails, as fungus and bacteria thrive in closed, moist areas. In more severe cases, you may need to get a prescription from a doctor.

In conclusion, if you have onycholysis, the key is to keep everything clean and dry. Thus, bacteria and infection have a minimal chance of finding a place to grow.  


Onycholysis – American Osteopathic College of Dermatology (AOCD). Onycholysis – American Osteopathic College of Dermatology (AOCD). Accessed August 16, 2016.

Result Filters. National Center for Biotechnology Information. Accessed August 16, 2016.

What Good Does Niacinamide Do?

I prescribed a patient Niacinamide for prevention of actinic keratosis (premalignant tissue) as per a study done in the NEJM in December 2015. “First of all, they look like horse pills,” the patient said. “How does this work? Is it really necessary?”

Niacinamide is structurally related to Niacin (Vitamin B3), and is converted into other substances (NAD, NADPH). These substances are crucial in regulating cellular energy levels. NAD is bound by the enzyme poly-ADP-ribose-polymerase 1 (PARP-1). This enzyme has important roles in DNA repair and expression of inflammatory messengers.

Niacinamide exerts an anti-cancer effect after it converts to NAD and activates PARP-1. Whether all patients who have significant history of skin cancer and premalignant tissue should take niacinamide is not clear. If a patient is niacin deficient, then they are more likely to develop a wide range of cancers. Giving individuals excessive Niacin levels may not accomplish anything as is often the case with”supra physiologic” doses of vitamins.


Australas J Dermatol. 2014 Aug;55(3):169-75. doi:10.1111/ajd.12163.

 J Med Chem. 2016 Jul14. [Epub ahead of print]

J Nucleic Acids 2010 July 25

Does Circumin Have Anticancer Purposes?

A patient asked me about circumin. Circumin is a chemical that is found in Turmeric, a plant indigenous to Asia and some parts of Africa. Turmeric’s primary use is in spices, food products, and clothing dyes, but it’s not prominent in the medical field.

While laboratory studies suggest that circumin may have some anti-inflammatory and anticancer uses, there are no reports of these findings in people yet. Hence, the research on circumin and its medical benefits remains in progress.


Medicines to Reduce Breast Cancer Risk. 2014.

Turmeric. NCCIH. Published March 2007. Accessed July 7, 2016.