For this holiday season, our clinic will be closed from December 24, 2020 to December 31, 2021, although we will continue to answer phones to book appointments during regular office hours.
The office will be completely closed from January 1 to January 3, 2021, and we will not be answering phones on those days. We will also be closed all statutory holidays and including Easter Monday. Thank you and have a great holiday season! See you in 2021!
A phase 2b study by Asana Biosciences regarding a novel new medication for moderate to severe chronic hand eczema has shown some encouraging results. The medication is called gusacitinib and is a dual JAK/SYK inhibitor. The study showed statistically significant improvements in chronic hand eczema severity compared to placebo. It had an acceptable safety profile and was well tolerated. The most common side effects were headache, nausea, nasopharyngitis, and upper respiratory tract infection. A phase 3 trial is being finalized.
Cryomodulation and nanosecond pulsed electric field treatment are two new technologies for the treatment of benign lesions like seborrheic keratoses. Cryomodulation is a technique using cooling technology to treat sunspots and seborrheic keratoses. The first to market device is Glacial RX by R2 Technologies.
Another new technology is nanosecond pulsed electric field treatment, which is a nonthermal, energy based technology used to treat seborrheic keratoses and other conditions. It will be interesting to see how effective these two new technologies will be.
A recent article in Dermatologic Surgery suggests that injectors (and patients) should be aware of the effects of needle size on the properties of fillers. Various types of fillers (monophasic and biphasic) were injected through 30G needles and the size and properties of the fillers were analyzed after they had been injected through the needles.
Both monophasic (e.g. Juvederm products) and biphasic (e.g. Restylane) fillers were affected by the smaller needle size. They were affected in terms of the size of the extruded particles and in the properties (G’) of the extruded particles. Interestingly, biphasic fillers seemed to be affected more than monophasic fillers. In addition, larger particles seemed to be affected more than smaller particles as we would intuitively expect.
Injectors should consider the size of the needle being used to inject fillers (especially biphasic fillers and fillers of larger particle size) as this might affect the performance and durability of the filler.
Reference:
Soft Tissue Filler Properties Can Be Altered by a Small-Diameter Needle. Dermatol Surg 2020 Sep;46(9):1155-1162.
Nuceiva is the newest neuromodulator on the market for the treatment of glabellar frown lines. Whereas Botox is referred to as abobotulinumtoxin A, Nuceiva is referred to as prabotulinumtoxin A.
Similar to other brands such as Botox, Xeomin, and Dysport, Nuceiva™ works to smooth out creases in the face by decreasing muscle contraction.
It has been approved by Health Canada and the FDA.
Marketed as Jeuveau by a company called Evolus in the United States, it originated with a South Korean company called Daewoong. Nuceiva™ was authorized for sale by Health Canada in August of 2019 and was subsequently officially brought to the Canadian market by Clarion Medical Technologies in October 2019. It is also available in the European Union.
Nuceiva™ usually lasts about 3 to 4 months although this varies from person to person. A study published in Dermatologic Surgery in 2019 showed similar efficacy to Botox.
Bleach baths are a controversial therapy for patient with atopic eczema, also known as atopic dermatitis (AD). In recent years, there has been an increase in the use of bleach baths to decrease the severity of the eczema. However, a recent review showed that while bleach baths did seem to decrease the severity of atopic eczema, it was no more effective than water baths alone. There has been a lot of research into the effect of bleach baths on Staphylococcus bacteria and it seems like the concentration of bleach used in bleach baths may not be high enough to kill bacteria. There may be other anti-inflammatory properties that have yet to be discovered.
With all of the conflicting data out there, the best summation is probably what was stated in the latest Canadian consensus statement on pediatric atopic eczema: “bleach baths have not been consistently shown to improve outcomes in AD and may be used at the discretion of the treating health care provider.”
Reference:
Lansang P et al, Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis. J Cutan Med Surg.2019;23(5):32S-39S.
Pulsed dye laser (PDL) is a very effective treatment for redness of the face due to enlarged blood vessels. It has proven to be very safe and effective. However, there is some discomfort from the laser pulses and while most patients have no difficulty tolerating treatment without any anesthetic, some patients do find it difficult to tolerate. Topical anesthetic can be used to decrease the discomfort of laser treatments but there has always been the question of whether the vasoconstrictive properties (i.e. constriction of blood vessels) of the anesthetic might have an adverse effect on outcome if you are trying to get rid of blood vessels.
A recent study by Chunharas et al in April of 2020 (Lasers Surg Med. 2020 Apr;52(4):307-314) demonstrates that topical anesthesia with lidocaine and tetracaine do not interfere with the efficacy of pulsed dye lasers. This is great news for those who want to receive treatments with pulsed dye lasers.
Thank you for your patience! As Phase 2 is set to open on June 12, 2020, we are happy to announce that we are reopening as well! We have been following the Chief Medical Officer of Health instructions and have therefore not been able to see any of our patients since March 16, 2020, except for skin cancer patients and those with urgent needs.
We are happy to announce that we will be booking appointments for all those we had to cancel over the last few months, as well as accommodate those on our wait list. We look forward to see you back again! We thank you for your patience and understanding as we ourselves need to go through our phased approach to booking.
Sincerely,
Dr. Nakatsui
In 2002, Botox (onabotulinumtoxin A) was the first botulinum toxin to gain FDA approval for the “temporary treatment of glabellar lines in adults.” A recent study published in Dermatologic Surgery reviewed two Phase 2 randomized, multicenter, double-blind, placebo controlled trials with 2100 patients showed that a new version called prabotulinumtoxin A had a similar onset of action, duration of action, and adverse event profile as compared to Botox. On the market currently, we have Botox, Dysport, and Xeomin for the treatment of lines and wrinkles. We may see another agent available soon.
References:
1. Dermatol Surg. 2019 Dec;45(12):1610-1619
Thoughts on COVID-19I have uploaded a video about my thoughts on some of the data about COVID-19 put out by Alberta Health. I have also included a website (link below) that has an interesting graph that shows what happens when a country starts to gain control over COVID-19. You may need click on the title of the blog to access the video and the link. Keep in mind these are my opinions only and may be incorrect. I hope you will find some of this interesting. Stay safe.
Dr. Nakatsui
Link to Aatish Bhatia’s graph on logarithmic Trajectory of COVID-19 Confirmed Cases
Putting on masks is something new to many people. In this era of COVID-19, social distancing, and trying to avoid spreading the virus to each other, masks may be one additional layer of protection. It is by no means 100% effective but if it does seem to reduce risk.
I have put together a video on how to apply these masks safely. If you know someone who might benefit from a simple overview, please send this on to them. In addition, I have an infographic on masks that I think is informative. Unfortunately, our blog only displays small thumbnails and I need to contact our web designers to change this before I post it. Stay tuned. Hopefully by next Tuesday I will post the infographic. You may need to click on the title of the blog to access the full blog. Stay safe.
Dr. Nakatsui
Temporary ClosureOn Monday, March 16, 2020, the Nakatsui DermaSurgery Centre decided to take a leading initiative and temporarily close operations to help mitigate the spread of COVID-19. This was not an easy decision. In the end, we are confident that this was the best decision to protect our patients, our staff, and our community. We have stopped all non-essential services and are in the process of contacting patients who were scheduled to see us in the next two weeks to let them know what is happening. We will do our best to reschedule everyone as soon as possible once the situation improves. For our current patients who have more urgent medical needs, Dr. Nakatsui will make himself available to see you.
It is important to remember we should not panic as this infection will be well managed for the vast majority of those affected. However, we must assist our health care system by “flattening the curve” and preventing the exponential rise in COVID-19 and reducing the number of serious cases.
We will still be answering our phones and responding to emails for the time being. If you have any questions and concerns, please feel free to contact us at 780-482-1414 or via email at info@nakatsuiderm.com. At this time, we are monitoring the situation daily and will post when we reopen.
For more information on COVID-19, please check the www.alberta.ca website. In addition, Dr. Nakatsui wanted to let you know about two other interesting links that contain updated information on global infection rates and a comparison between American and Canadian infection rates.
At our centre, we can treat a variety of skin conditions using the latest in laser technology. In this video, Dr. Nakatsui is treating veins located around the eye with the Cutera XEO 1064nm laser. It is really neat to watch because during treatment, instant results can be seen. For more information, please contact our clinic at (780)482-1414.
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In any field, especially medicine, it is always important to constantly learn and improve. To quote Vince Lombardi, one of the top coaches in the NFL, he said that “perfection is not attainable, but if we chase perfection we can catch excellence”. Dr. Nakatsui is in constant pursuit of perfection.
Recently, Dr. Nakatsui attended a conference sponsored by Allergan the producers of Botox, Juvederm, and Belkyra. The conference was attended by the top injectors in Canada to watch and discuss the newest and best techniques for Botox and filler injections. With these pearls and new techniques, Dr. Nakatsui is excited to pass along these techniques to his patients! For more information or to book a complimentary consultation with Dr. Nakatsui, please contact our clinic at (780) 482-1414.
In this video, we are seeing what Dr. Nakatsui sees when performing surgery. This surgery is the removal of a lipoma, a benign fatty growth that can occur anywhere on the body. Many are small, but lipomas can grow very large in size. Dr. Nakatsui makes a small excision where the lipoma is located. This particular lipoma came out relatively easily, but keep in mind that not all lipomas will be this easily extracted. To close the surgery site, Dr. Nakatsui uses a subcuticular running stitch.
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A recent study on SPF published in the Journal of the American Academy of Dermatology (JAAD, 2018; 78: 902-910) demonstrates that higher sun protection factor sunscreens really do provide additional benefit. This study evaluated skiers in a double-blind, split-face, randomized study. In this study, skiers in Vail, Colorado wore SPF 50 on one side of the face and SPF 100 on the other side of the face. They were allowed to do their normal activities and were then evaluated the next day to see if there was any evidence of sunburn erythema. The SPF 100 sunscreen side was found to be significantly more effective in protecting against sunburn.
The study supports our belief that if you are going to be out in a lot of sun, the higher the sun protection factor, the better! Another factor that may be important is that many of us apply far less sunscreen than we should, so you might think you are getting an SPF 50. However, you might be applying such a thin layer that you are only getting the equivalent of SPF 20! Consequently, make certain you apply enough sunscreen to provide adequate protection and if you decide to go to a higher sun protection factor, all the better. Your skin will thank you.
Sunscreen helps protect against the development of sun damage and skin cancers. We have many patients who either worked or played outside for many years and they are now seeing the after effects many years later. If you don’t believe it, go to Australia and see what percentage of people have skin cancer. Skin cancer is not fun. Protect your skin–it will thank you later.
Scar treatment can be challenging and requires a multi-dimensional approach in order to be successful. A scar can be the centre of attention but can also be a source of annoyance. For some individuals, scars are a part of who they are, whereas for others they are intrusive and cause insecurity. They can be caused by a variety of reasons such as acne scarring, trauma, and surgery.
Some individuals have thickened keloid scarring, where a scar becomes raised and discoloured. In order to treat the thickened aspect of the scar, many times cortisone injections will be utilized to reduce the thickness of the scar.
On the opposite end of thickened scars, people may get pitted scars where the skin sinks in various regions. These types of pitted scars can be tricky to treat; however, with improvement in technologies and techniques, pitted scars can often be improved. In some cases, Dr. Nakatsui will use an ablative laser to smooth out the skin and reduce the harsh edges that cause shadowing.
A new approach is to promote collagen re-growth in the region. Through the use of a technology called Percutaneous Collagen Induction (PCI), many tiny needles create tiny holes in the skin. The creation of these tiny holes stimulates collagen formation to help fill in the areas of depressed scarring.
Scar treatment also encompasses hyperpigmentation (darker pigmentation), hypopigmentation (lighter pigmentation), and erythema (redness). Hyperpigmentation and erythema can be treated fairly successfully with various lasers. Unfortunately, hypopigmented scars are more difficult to treat and currently there is no reliable solution to permanently bring colour back into a scar once the colour is gone.
Certain scars due to trauma are very visible to the human eye because the lines of the scar are fairly linear. Surgically removing the scar and carefully using various closure techniques to break up the linear scar can greatly reduce the appearance of a scar.
Scarring can impact an individual’s self-confidence. With current technology, scars can be improved. For those with scars that affect their self esteem and their daily living, don’t get discouraged as there are many great options to help treat your scars.
For more information regarding the various treatment options for scars please visit: scar revision for more information or you can contact the Groot DermaSurgery Centre at (780)482-1414.
In today’s society having a full and lush beard is becoming more and more of a fashion statement for men. While some men are born with thick facial manes, others require treatment to aid in thickening up their beards.
Not all men are lucky like actor Kristofer Hivju (photo), more popularly known as Tormund from the HBO hit show, Game of Thrones (most of the staff at the Groot DermaSurgery Centre are very big fans of Game of Thrones).
Dr. Thomas Nakatsui, a board certified Dermatologist and hair transplant specialists, has been performing hair transplants for over 18 years. The exact reasons why men come in for a beard transplant vary.
Some men want to increase thickness, while some men have suffered some form of trauma that caused an area to scar, therefore leaving a portion of facial hair missing.
As with any hair transplant, artistry plays a major role in how the end result turns out. Hair transplants need to look natural and undetectable in appearance. Old forms of hair transplants, “plug transplants”, have yielded unnatural and very detectable results.
Having undetectable results is even more paramount whenever dealing with the face as it is always front and center. Any irregularities can be easily spotted.
To address this issue, Dr. Nakatsui follows the patient’s natural flow, angle, and direction of their beard. If hairs are placed in any strange angle, it will become very apparent that a hair transplant was performed once the hairs have grown in.
The size of the graft is important as well. A graft is a natural grouping of hairs that come in 1, 2, or 3 hair bundles. Dr. Nakatsui typically utilizes the grafts with one hair when it comes to beard hairs.
Beard hair transplants can be a great tool to help thicken up a beard. One thing to consider before having a beard hair transplant is that the donor hair, which is usually taken from the back of the scalp, may have different texture and/or colour than the recipient bearded area.
Once the transplanted hairs are placed, it will hold the same characteristics as the area where it was taken from. If there is a significant difference between the donor hair at the back of your scalp and your beard hair, it can potentially become visible and unnatural.
The beautiful thing with a beard hair transplant if it is done correctly is that it now gives the individual the choice whether or not they want to grow a beard or be clean shaven.
Because of the incredibly small incisions that Dr. Nakatsui makes during the procedure, a patient can be cleanly shaven and have no trace of scarring to the area.
For more information regarding hair transplants, please visit drnakatsui.com.
Pumpkin spice everything, leaves falling, and sweaters everyday can only mean one thing: Fall is here! This beautiful and romantic time of year can also mean changes in weather and temperature which can affect your skin. Everyday events that we take for granted, such as stronger winds, can strip away moisture from the skin. When this moisture is stripped or there are irritants in the air, your skin can become itchy or even a rash can appear! Here are some basic tips to help your skin retain moisture. The following are only tips and does not replace seeing a qualified dermatologist.
Not only is it good for the environment to decrease the amount of water used, limiting the time spent in the shower will prevent your skin from losing its moisture barrier.
Closing the bathroom door to keep moisture in the bathroom is a great way to keep your skin moist.
Hot water can irritate the skin. Try dropping the temperature to a warm setting.
Use unscented soap products on your skin.
Gently pat your skin dry with a towel.
Immediately after drying your skin, apply a non-irritating moisturizer to your skin.
Washing your hands will strip away moisture from your skin. Many individuals, especially those in the healthcare field, wash their hands several times a day. After washing your hands, lightly pat dry your hands and then immediately apply moisturizer. This will help keep moisture in your hands.
Wearing gloves when outside is not only a fashion statement, it can help protect your hands from the elements! Gloves can also help retain moisture on your skin.
Gloves also act as a physical barrier between your skin and other substances in your environment, such as chemicals, potential allergens, and objects than can cause little cuts.
Find a non-irritating laundry detergent that works for you. It will take some trial and error to find the perfect fit. Try using an unscented/hypoallergenic detergent to avoid irritation.
Cozying up next to a fireplace on a chilly autumn day can truly warm the soul. Just remember fire or any heat source can dry your skin. Try limiting your time spent directly beside any heat source. Also, don’t forget that if you are using a fireplace to have a window or door open to allow fresh air to circulate within the home!
Humidifiers are great tools to help bring back moisture into the air and decrease the chances of your skin drying out.
Yes, even with the limited hours of sun and increased cloudiness, wearing sunscreen on open portions of skin is still very important throughout the year! Many sunscreens will also provide a moisture barrier to help retain that needed moisture.
The autumn season is an incredible time of year. Don’t let dry skin bring an end to your fun. If you find that your are experiencing prolonged periods of dryness or even a rash, consult with your Dermatologist!
We’ve heard it all before: a woman falls deeply in love with her boyfriend, Kevin, and decides to have his name tattooed across her arm only to become heartbroken the following week. She is now stuck with this unwanted tattoo across her arm.
Years ago, she only had a few options: live with the regret and have his name forever inked on her skin, or try to cover it up with a second tattoo on top of her current tattoo. Various creams have been suggested; however, many of them were either ineffective or, worse yet, caused scarring due to the strong nature of the creams.
The newest and most advanced technique for removing unwanted tattoos is with laser therapy. At the Groot DermaSurgery Centre, we use the Q-switch Alexandrite laser. Various lasers are used for various conditions such as excessive hair, mole removal, or unwanted blood vessels. Each one of these conditions will require a different wavelength light.
Specific to tattoos, the laser penetrates the skin at a specific wavelength with the goal of breaking pigmented particles. Your body’s immune system then removes these pigmented particles over time. After a few treatments, the tattoo can potentially be completely erased from a person’s skin.
As with any procedure, especially those that involve lasers, it is always important to be aware of the risks and precautions surrounding the treatment. Regarding laser therapies for tattoo removal, one potential risk is hypopigmentation, or the loss of colour, of the skin. Or conversely, a person may get hyperpigmentation, or the increase in pigmentation in the skin. The laser used in tattoos cannot distinguish between naturally dark pigmented skin and a tattoo, therefore, when the tattoo is being removed, surrounding skin can potentially be affected as well.
At the Groot DermaSurgery when consulting an individual about tattoo removal, we highly suggest that the individual not have any tan in their skin before and after treatment for these exact reasons. As always, speak to a certified medical professional when dealing with any treatment. If you have any questions or you would like more information, please do not hesitate to contact the Groot DermaSurgery Centre and book a complimentary consultation for your specific needs or please visit this link.
*At the Groot DermaSurgery Centre we love Kevins and even employ a Kevin at our facility! We only used your name as an example*