Tar Products Can Pave the Way to Healthier, Clearer Skin

Dermatologists have always been using tar products to treat skin diseases. For example, tar is an essential part of psoriasis therapy, either on its own or combined with ultraviolet light. Dermatologists also use it to treat eczema, though this is less common.

I’ve stopped recommending tar products in my practice, mostly because it’s OTC and I’ve forgotten about it. There is also an unproven concern that it can cause cancer, which is (understandably) a large deterrent. Furthermore, patients do not appreciate its pungent smell.

So when patient recently asked me about how my recommendation of tar products worked, I really didn’t have a clear answer. Thus, I did some research into the subject and learned some interesting things.

First, what makes up tar? Tar is a broad term that refers to organic plant matter that can occur naturally. You’ll find tar most commonly in pits, where you’ll will also find pitch and asphalt. One can also create tar-like products by dry heating coal to about 1200ºC. At this temperature, the coal melts into a thick liquid called crude coal tar.

Crude coal tar contains an estimated 10,000 high molecular weight hydrocarbons and aromatic (aka “odorous”) polycyclic hydrocarbons. These specific aromatic polycyclic hydrocarbons may help treat skin diseases.

Second, how do tar products interact with skin cells? Skin cells (keratinocytes) absorb and break down these aromatic polycyclic hydrocarbons using the same system that breaks down natural plant flavonoids. (Flavinoids are ubiquitous pigments in plants. Research indicates they have health benefits).

Furthermore, there is some research to suggest that the aromatic polycyclic hydrocarbons can help the barrier function in atopic dermatitis normalize. It may also help block the effects of inflammation in this particular disease.

In conclusion, I can now recommend tar products to patients with more confidence. It comes in useful for patients as an alternative to topical steroids, and for maintenance of stable chronic skin diseases.


From Feldman et al UpToDate


Wikipedia for “tar” and flavonoids


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). http://www.aocd.org/?page=onycholysis. Accessed August 16, 2016.

Result Filters. National Center for Biotechnology Information. http://www.ncbi.nlm.nih.gov/pubmed/25512134. Accessed August 16, 2016.

Terrasil (Thuja Occidentalis) Ointment: What It’s For

Recently, a patient asked me about using Terrasil for wart removal. Thuja Occidentalis Ointment, also known as Terrasil Wart Removal, is a homeopathic remedy for warts.  Natural ingredients include: organic beeswax, cedarwood oil, and jojoba.

Because Terrasil is a homeopathic remedy and not a drug, the FDA does not regulate non-drug substances for accuracy of the company’s claim of effectiveness. Thus, there is no scientific evidence yet to support the claim that homeopathy is an effective method of treatment. It may work, but the company doesn’t need to prove it.

But this patient’s question jogged my memory about an article in the New England Journal of Medicine in 2004. The article describes a clinical trial of human alpha-lactalbumin coupled to oleic acid that was highly effective for treating human warts. The substance, known as HAMLET, is purified from human breast milk and applied topically.

In an accompanying editorial, commenters expand the possibilities for HAMLET treating malignant tissue such as HPV induced cervical cancer and cutaneous squamous cell carcinoma (which may have HPV as a cofactor with ultraviolet light). HAMLET is used to treat cells causing apotosis (cellular death) and appears to be a leave normal cells alone. Thus, the side effects on normal tissue would be minimal.

Medications like HAMLET are no doubt in the pipeline. Additionally, I think it’s curious that breast milk may provide answers to some of our most pressing medical problems. There may be room for more research there.


Bavinck JNB, Feltkamp MC. Milk of Human Kindness? — HAMLET, Human Papillomavirus, and Warts. New England Journal of Medicine N Engl J Med. 2004;350(26):2639-2642. doi:10.1056/nejmp048086.

Label: TERRASIL WART REMOVAL- thuja occidentalis ointment. DailyMed. https://dailymed.nlm.nih.gov/dailymed/druginfo.cfm?id=119689. Published February 28, 2014. Accessed August 1, 2016.

Castor Oil Has Skincare Purposes I Didn’t Know About

A patient came to me having tried a number of remedies, including castor oil. I’ve heard of this, but I didn’t know if it had any relevance to dermatology. I decided to do some research on the topic.

The oil itself comes from the castorbean, which is native to areas of Eastern Africa and the Mediterranean. Specifically, the castorbean’s seeds contain the best source.

People know castor oil as a laxative ingredient, but it also treats skin ulcers and other wounds. It comes as an ointment or a spray, and its brand names are Granulex, TBC, Vasolex, and Xenaderm.

The oil is also found in cosmetic products like creams and lipsticks. When combined with Glyceryl Ricinoleate, it absorbs UV light. Overdoses and allergic reactions may occur if product is not used as directed.


Castor Oil/Peru Balsam/Trypsin (On the skin). National Institute of Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/pmht0009483/?report=details#uses. Published July 1, 2016. Accessed August 16, 2016.

The Four Cosmetic Intervention Techniques Backed By Science

Cosmetic intervention is a hot-button issue in the dermatology industry. There is ongoing research into what works and what doesn’t. Everyone wants protect their facial skin from damage, and everyone wants to avoid wrinkles. As a practicing physician, I only use techniques that have been proven to work through scientific studies and trials.

Right now, there are only four cosmetic intervention techniques that fulfill that criteria.

  1. Sunscreen, daily: ultraviolet (UV) light and natural aging causes most damage to the skin. Protecting your fibroblasts from UV damage lessens their impairment. It also protects the epidermis, melanocytes, and skin-associated immune cells from UV damage.
  2. Retinoids: A retinoid (topical derivative of Vitamin A) applied to the skin helps fibroblasts “wake up.” The activation of fibroblasts produces more collagen. Since fibroblasts lose function with age, retinoids help restore fibroblasts and repair normal function
  3. Fillers: Adding volume to the dermis actively stretches the fibroblasts and wakes them up. As a result, fibroblasts begin to produce more collagen, much like the response to retinoids.
  4. Carbon Dioxide Laser Resurfacing: Usually a laser will remove a thin layer of tissue. Then stem cells from hair follicles resurface new dermis and epidermis.

I recommend that my patients use options 1-3. Resurfacing works, but it’s expensive, risky, and involves significant down time.

In conclusion, these four techniques are the only cosmetic intervention methods that scientific evidence can back.  Though this may seem limiting, there is ongoing research into other techniques, as people are eager to seek out alternative methods. But since there is nothing scientific to back up alternative methods, we’ll just have to wait and see.

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

Can Apple Cider Vinegar Clear the Skin?

Many patients tell me that apple cider vinegar helps reduce wrinkles and signs of aging. Since I’ve never heard of any scientific research done on it, I decided to look it up. I found nothing in any medical database.

There is a rumor circulating that apple cider vinegar enhances the skin. But there’s no scientific evidence just yet. We’ll just have to wait and see.

Mother Dirt Nurtures the Good Bacteria in the Skin

I heard an advertisement for a brand called Mother Dirt the other day. I had never heard of their products, so I figured I would do some research. I found out that it’s a new skincare line that nurtures the good bacteria present in the skin.

Most skincare products kill all of the germs on our skin, including the good bacteria living there. Researchers claim that this is more harmful than healthy for us, as it disrupts that natural order. We are sterilizing our bodies, which strips the skin of essential bacteria and leaves it prone to infection. In short, we are too clean!

Mother Dirt’s products are full of Ammonia-Oxidizing Bateria. AOB is healthy for the skin in the same way probiotics are healthy for the digestive system. Good bacteria will balance out cleanliness, health, and natural order.

You can check out Mother Dirt’s website and product line here.


Mother Dirt | Rethink Clean and Health Skin. Mother Dirt | Rethink Clean and Health Skin. http://www.motherdirt.com/. Accessed June 30, 2016.

Collagenase Santyl Ointment for Chronic Wound Care

A visiting nurse suggested Collagenase Santyl Ointment for a patient who had chronic leg ulcers. I had never heard of this chronic wound care product before, so I decided to do some research on it. It turns out Santyl Ointment is a prescription medication that removes dead skin from chronic surface wounds. Dead skin buildup interferes with the healing process.

The ointment is prescribed for many kinds of chronic wound care: diabetic ulcers, venous ulcers, and areas that have been severely burned.

How to use Santyl Ointment:

  1. Clean the affected area.
  2. Apply the amount of ointment instructed by your doctor.
  3. Cover the area with a clean gauze bandage.  


What is Collagenase SANTYL Ointment? Collagenase SANTYL Ointment. http://www.santyl.com/. Accessed June 30, 2016.