Skin and Hair

What can I do to improve my brittle nails?

DEAR DOCTOR K: As I've gotten older, my fingernails have become very brittle. They chip, break and split easily. I've also noticed ridges. What can I do?

DEAR READER: Many of my patients notice that their fingernails become thinner, more brittle and fragile with age. Nails may split lengthwise, or separate in thin layers at the tips. The nails may look different as well. They may become yellowed or dull, and many develop thin, vertical ridges.

What is actinic keratosis — is it skin cancer?

DEAR DOCTOR K: I saw my doctor about a patch of rough, brown skin that I noticed on my upper arm. He said it is actinic keratosis and needs to be removed. Is it cancer? How will it be removed?

DEAR READER: Actinic keratosis (AK) is a precancerous skin condition. That means it is not cancer now, but is likely to become cancerous if left untreated. AK appears as raised, scaly pink or red-brown rough patches on the skin. The patches are most likely to appear on the face, back of the hands or other areas commonly exposed to the sun. They can cause discomfort and itching.

What happens to our skin as we age?

DEAR DOCTOR K: As I've entered my 40s, the skin on my hands and face has started to change. What happens to our skin as we age?

DEAR READER: The shortest answer is that our skin gets old, like the rest of us. In fact, the three layers of skin get old in different ways. The skin's outermost layer, the epidermis, forms a protective physical barrier. The dermis, or middle layer, contains collagen and elastin, which provide strength, firmness and elasticity. It also contains blood vessels, immune cells, nerves and glands that produce sweat and oil.

Do I need to get the shingles vaccine?

DEAR DOCTOR K: I have never had chickenpox. Do I still need to get a shingles vaccine?

DEAR READER: Not everyone knows the connection between chickenpox (a childhood disease) and shingles (a condition that usually hits adults). So let's begin with that. Chickenpox and shingles are both caused by the same virus: varicella-zoster virus (VZV). Once you have had chickenpox, VZV remains in your body's nerve tissues for the rest of your life, alive but inactive.

How do you treat eczema without steroids?

DEAR DOCTOR K: My 21-month-old daughter has eczema. Is there any way to treat this condition without steroids?

DEAR READER: Eczema, also called atopic dermatitis, is more than just dry skin. It is an inflammatory skin disease that often begins in infancy as an intensely itchy rash. Scratching leads to further irritation. The injured skin becomes chronically inflamed and more vulnerable to infection.

What can I do about anal itching?

DEAR DOCTOR K: I'm embarrassed to ask this question, but here goes: The area around my anus itches constantly. What can I do?

DEAR READER: I'm sure other people have this issue and are also embarrassed to ask about it -- so I'm glad you did. When my patients mention this problem to me, I ask them how long it's been bothering them. They often say several years. Since they've seen me several times during those several years, and they're mentioning it only now, it means they've had difficulty talking about it.

What can my dermatologist do for my wrinkles that’s budget friendly?

DEAR DOCTOR K: I'm in my 60s and already have a lot of wrinkles. What can a dermatologist do for me that will make a difference but not be hugely expensive?

DEAR READER: Age isn't kind to skin. Years of sun exposure leave their mark in the form of fine lines, wrinkles and discoloration. I spoke to my colleague Dr. Kenneth Arndt, clinical professor of dermatology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Why do some scars last while others fade over time?

DEAR DOCTOR K: How and why does a scar form after injury or surgery? Why do some scars last, while others fade over time?

DEAR READER: It's actually amazing how few scars most people have despite a lifetime of injuries to the skin. Skin heals in a remarkably complicated process. When you cut yourself (or a surgeon makes an incision), three processes take place in roughly the following order, although they often overlap.

How can I protect my kids from frostbite?

DEAR DOCTOR K: My kids love to play outside, even in the cold and snow. How can I protect them from frostbite?

DEAR READER: Frostbite, ironically, results from the body's attempt to protect itself against the cold. Our body cares much more about the temperature of its inside self than the temperature of its outer self. What do I mean? The normal temperature inside our body (our "core temperature") is around 98.6 F. The organs inside -- the brain, heart, lungs, liver, kidneys and others -- function best at that temperature.

What causes under eye bags, puffiness, and dark circles?

DEAR DOCTOR K: Why do I have bags, puffiness and dark circles around my eyes? What can I do about it?

DEAR READER: My Harvard Medical School colleague Dr. Robert Shmerling wrote about this a couple of years ago in the Harvard Health Letter newsletter. Here's some of what he said: Gently pinch the skin under your eyes and give it a little tug. You'll feel that it's a little looser and thinner than skin elsewhere. It's also looser and thinner than it used to be.