Dr. Rachel Ness (transcript)
Main Street
Step into the world of optimal health where we often focus on our heart, lungs, and internal organs. But pause for a moment - have you considered the spectacular universe of your skin?
Enter Dr. Rachel Ness from the Fargo Center for Dermatology. As a board-certified dermatologist, she's the expert on the wonders of skin care. Dr. Ness is my guest. Welcome to Main Street.
Dr. Rachel Ness
Thank you so much for having me today.
Main Street
As we said off the air, everyone has skin. This is an important topic, yet I think many folks really have never been examined if you look at national statistics relative to visits with dermatologists. Tell me, Dr. Ness, what are the best practices for the frequency of dermatology visits? And does age play a significant role in determining those intervals?
Dr. Rachel Ness
That is a wonderful question and a question we definitely get in our office every single day, and that actually is very individual. The answer is because it does definitely play off of a little bit of your genetics or any sort of risk factors that you might have. And so what I always typically say is, when in doubt, just come in for a baseline skin exam and then we will sift through all those things. We'll do this full skin exam if you would like us to.
And then what we do is we look at your personal risk factors, see if you have any current atypical moles, skin cancer, skin disease. We also go through your family history. And because there's certain types of skin cancers that are much riskier to have in your past medical history than others, and we kind of take those and we kind of put it into an equation for us, and then we can tell you, okay, you need to come back six months, four months a year. Some patients, we say, you know what, based on your risk factors, you have very little risk factors. And if they have a primary care physician, I'll discharge them back to the primary care provider and say, come back when you or your primary care provider feels like you need another dermatology exam. So it's all over the board.
Main Street
I think we're blessed here in Fargo to have you here, but there are not dermatologists all over the state. What's your advice to folks who might be quite some distance from a dermatologist?
Dr. Rachel Ness
No. That's great. Just like I was telling people, there isn't a dermatology residency in the state of North Dakota. So just I'm similar to all the dermatologists that do currently practice in the state. And we all had to go somewhere. So we all had to leave the state for four years and get our dermatology training and a residency elsewhere. And then definitely some of us came back here to the state of North Dakota. And so we're definitely under a shortage of dermatologists here. So definitely you can definitely find yourself maybe sometimes geographically restricted from a dermatologist that's nearby. But we do definitely have some great options as far as tele dermatology. So tele dermatology, you know, is one of those things that definitely grew, you know, during the Covid days. And it's here to stay. And so I'm now able to serve anyone in the entire state of North Dakota for to do to meet some of their dermatology needs.
Obviously, I haven't figured out how to do a biopsy, you know, over the computer. I, I can't do that. But we have been able to definitely look at rashes, manage acne, manage psoriasis, manage connective tissue diseases or other things. There's even some things like warts or other things that we can actually do medical management with prescriptions. And so I definitely I have some patients that go back and forth between actually in-office visits and tele dermatology.
What I always tell my patients is you do definitely need to check with your insurance. If you're choosing to go through insurance for your dermatology visit to make sure that is something that they're covering. I have other patients that decide, you know what, I'd rather pay the $200 office visit instead of driving seven hours across the state, taking a day off from work, and filling my tank up. You know both ways it ends up being cheaper for them just to, you know, pay for a tele dermatology visit. So I think that, you know, there isn't a ton of dermatologists in the state, but like I said, I was telling my patients that we get cancellations every single day. So if you've got a little bit of flexibility, we're oftentimes able to work people in within a couple of weeks to a couple of months.
Main Street
What about kids? And I'm thinking from my time when our kids were in our home, they were empty-nesters now. But oh my gosh, we went on this vacation and my son got this huge sunburn. I'm a terrible parent, and it's a couple of years later I'm thinking about skin and dermatology things. What do you what do you tell parents about their kids and skin and dermatology?
Dr. Rachel Ness
Yep. That's great. You know, and I was one of those kids. I had a blistering sunburn when I was a child. And I don't blame my mother, you know, for that. But that is a risk factor. So one of the things, because a lot of my patients have skin cancers, have atypical moles and they have children, you know. And so one of the things that I like to tell them is, you know, learn from your life lessons and protect your kids. And so announced, the prevention is worth, you know, a ton, you know. So one of the things is when kids are six months to a year, we can definitely start with actual sunscreens. But when you pick your sunscreen, I'm educating the parents. When they're that young, their skin is quite thin. So I have them pick a physical or mineral based sunscreen, so that would be something with zinc oxide or titanium dioxide. And pick that to start with. If they're six months and younger, we do not actually use sunscreens because their skin is too thin. It will absorb too much. So then we're only left with sun protection, some protective clothing which is described as a UPF. So protection is number one.
I also tell you that you can't change your genetics, your family genetics and risk factors, but you can change your environmental risk factors, you know, so educating your children about why they don't want a sunburn, why they don't want to use a tanning bed, why they don't want that blistering sun because of the statistics of increasing their risk of getting atypical moles or skin cancers or melanomas and some skin cancers can actually kill you. So definitely education and also educate the parents if there's anything new changing, you know, on your children to have them come in for that baseline exam so we can do some possible photography of any sort of moles or any sort of birthmarks that they have, and then we can let them know if they if they need to follow up with dermatology further on in life.
Main Street
We're going to talk about tanning beds here in just a little bit. But I want to ask you, what's involved for screenings for skin cancer? We've all heard, I think, these horror stories of family members, friends, others who maybe have gotten melanoma and then have been in real trouble. What is a skin cancer screening?
Dr. Rachel Ness
Great and we on our website we always say what to expect, you know, at your first visit, because that can be scary. And I think sometimes fear is what keeps people sometimes out of the doctor's office, whether it's a dermatologist or someone else. And I always tell people I love it. I'd rather treat a skin cancer when it's early and small versus when it's advanced or it's spread or metastasize, because I want to give my patients a small scar and not a large scar. So don't be fearful. Come on in if you've got anything that's concerning. So when you do come in and some of my patients come in on their on their own free will, some of them come in because their spouse or their parent has made has made them come in and think. That's the first thing I would say is, hey, you know, it's as a dermatologist, you know, we're all pretty good people, okay?
There's nothing scary here. We'll talk you through every part of the visit. And I always say the more skin I can look at, the better exam you'll get. So I would say I'm only going to look at as much skin as you're comfortable with me looking at. Most of the time I say, you know what? If you want to take off your undergarments, you certainly can. Otherwise you can keep those on. And I'll just look at any skin that you want me to. If there's anything you don't want me to look at, just let me know. And then I always offer a full skin exam. So I hate for a patient to come in and ask me for a mole to look at a mole on their right wrist, and I'm missing a melanoma on their back. You know, that's the last thing I wanted.
So we look at them head to toe, and after that, if we find something that's borderline or questionable, we might just do what we call it a monitor and measure. So we'll just take a measurement of it and some good photography of it, and then we may or may not have them follow up. I have other patients that you might anticipate a biopsy. Biopsy is nothing scary. Usually takes, you know, 3 to 4 minutes. You realize you leave with a little small bandage. We might take a portion of a spot that's suspicious, and then we call you in, usually less than a week and just let you know of those results. And so and then at that point, depending on the results of that, we decide when you're going to be coming back. So I always just tell patients that we look at everything, everything from we look at anything hair, skin or nail related. So we dig through your hair, mess up your hair a little bit. We look underneath your fingernails, you know, your nail plates, and we look at as much skin as we can.
Main Street
Looking at a map of the United States here in front of me, in front of me. Would you say that North Dakotans are more at risk about average risk or less at risk for these skin cancers than melanomas?
Dr. Rachel Ness
We're definitely a high risk population up here, you know, just with our high propensity Scandinavian skin, Caucasian, we call it our Fitzpatrick 1 or 2 skin types, which really is just those skin types that we tend to burn more than we tan. So we have higher risk. We also have intense intermittent sun, you know, so we our fair skin kind of is goes out in the middle of May June and we might get those sunburns early on. So that's where we get those blistering intense sunburns, which can be really, really quite risky, you know, in those. So so we're definitely a high risk population here.
Main Street
Now, the thing I've wondered about is certainly in summer everyone thinks, okay, sunscreen, yada yada. But what about wintertime? I'm only going out. My face is only exposed. I'm only going to be shoveling for a half hour. Whatever. Am I thinking wrong there about not thinking about caring for my skin even in winter?
Dr. Rachel Ness
Love that question. No, I do see sunburns even in the winter. You know, I've had a couple severe. Severe blistering sunburns when people when they're out there skiing, you know, they're taking off in these, you know, intense days because actually the sun can reflect off of our beautiful white snow, just like it can reflect off the water in an ocean, a lake, a pool. It can reflect off of that beautiful white snow, and we can get some pretty intense, blistering sunburns. But even when you're out there shoveling your sidewalks or those types of things, you can actually get some pretty intense sun. So it is a it's technically a year round commitment. Certain days are definitely more intense than others.
Main Street
We are enjoying our conversation with Dr. Rachel Ness. She's the owner and founder of the Fargo Center for dermatology. She graduated from the University of North Dakota and the UND School of Medicine and Health Sciences. How does the change in outside air temperature now that it's going to get cooler? And also the humidity change during winter affect our skin and overall skin health?
Dr. Rachel Ness
Well. We are blessed and cursed with four intensely different seasons here. Think in North Dakota. And so that's what makes it, you know, so fun, the diversity of our weather. It also is really quite difficult for our skin to acclimate, just as we personally have a hard time going from summer to fall to winter. Our skin also parallels that same difficulty and think it screams at us and dissatisfaction by becoming dry, cracked, itchy and comfortable. We call it our. We call it the winter itch. And definitely as we age that becomes more prominent because we all lose just those natural. We cut lipids or fats in our skin as we age, and so little changes in the temperature can definitely make a huge difference for us. So a lot of our patients, especially patients who have sensitive skin, dry skin, eczema, psoriasis, atopic dermatitis, we have a summer regimen and we have a winter regimen, you know, for them.
And they are drastically different. And so we definitely see lots of patients here for simple things and simple rashes that all we have to do is correct them by getting on the right products the right moisturizer moisturizers, the right cleansers, the right shampoos, the right sunscreens, just because there's a different product for every season. So we have you bring we literally say bring everything in that you're from your bathroom to your, you know, bedroom. Whatever's going on your skin, go through your shower, grab all your products, roll it in with the roller suitcase if you need to. And we sift through them and maybe identify some products that might be oil stripping, drying, or just not a good match for your particular skin type.
Main Street
You know, I was looking at the drugstore in preparation for this at lotions.
Dr. Rachel Ness
Yes.
Main Street
And it's like, Holy cow, there's a thousand of them. What should I look for generally, Dr. Ness?
Dr. Rachel Ness
It's overwhelming, you know, for the consumer. And, you know, one of the things is, you know, 15 years ago, we started our practice here at Fargo Center for dermatology. So actually, in August of this year, we celebrated our 15 year anniversary. Congratulations. Yeah. Thank you. That was it's huge and monumental for a practice. And one of the things when we started out, we've learned a lot of things over those, those 15 years. And what we found out is exactly what you're saying. Picking products is complicated. It's hard, it's time intensive, and you almost need a degree to kind of sift through all those different products on the shelves when you go out to your local retail store. So one of the things is starting over 15 years ago, we started just with 2 or 3 products just to basically have on our shelves.
You know, here's how to pick a sunscreen, here's how to pick a moisturizer. You know, now we've got over 100 products for people to kind of help pick through so we can help. Are you we basically say, are you an acne prone patient? Are you a eczema patient? Are you a psoriasis patient? Are you dry? Are you oily? Are you normal? What are you trying to correct? Are you trying to connect correct your dry skin? Are you trying to connect your brown spots, your red spots? You have rosacea.
What are your problems? Because and then we try and put together a regimen because honestly it's too complicated you know. And so we also try and keep things simple. We also ask patients say okay what can you handle. Can you handle 1 or 2 things or can you handle 3 or 4 products. And we try and pick a just a skin regimen that works well for the patients skin types and skin diseases. You know, you don't want to use a thick moisturizer on someone's face who they also have acne tendencies, you know, type of thing. And so it's, you know, it's really the kind of that art, the art of medicine and the art of product selection, you know, to find the right product for each person.
Main Street
You know, soaps were right in there, too, at the drugstore. For me, it's just like, okay, I always grab this one and I, my wife will tell you, I go in the store, get what I need, and I'm out of there. But this time I actually looked around and she's like, oh my gosh, same thing with. With soaps and shampoos. It probably fall in the same male too. What generally do advice I guess you have for folks relative to soaps and shampoos that they use almost every day?
Dr. Rachel Ness
You know, I tend to in my the patient population I typically seen isn't the people with normal skin. It's the people who have tendencies for maybe a little bit more dry or irritated or sensitive skin, or maybe a higher incidence of allergies in my patients than the typical population. So one of the things when we're having a pick, we often we actually want them to pick a non soap cleanser. Soap by definition is very very oil stripping. So we want to pick cleansers that actually clean the skin but leave the oils and lipids intact, those natural oils and lipids intact. Because that's actually what's important to keep your skin barrier intact. Because if it's if we strip all the oils off of your skin with a harsh soap that might be cleansing you, great. But it's taking all those oils. You're going to be susceptible to help find cracks and fissures in your skin, and you'll actually be more susceptible to viruses, illness, bacteria, infections, those types of things.
Main Street
Are there any off the shelf brand names that you might be able to help us with?
Dr. Rachel Ness
Yeah, absolutely. Some just general product names. If you're shopping at your general retail store in the corner, you know, a good products in general appear to be Vanna Cream is a very good line for people, especially with very sensitive skin. You know, it's free of dyes, parabens, formaldehyde and lanolin all the typical high allergens. Another one, Sarah V Cetaphil, are very common lines. If I say if we're trying to do over and over the phone, consult with someone, say generally you can start with those, but even within those product lines, you've got a little bit of selection that you've got to make.
Main Street
And that advice holds for men and women with the brands that you just talked about.
Dr. Rachel Ness
You are correct. Yep. Both of those are very unisex lines.
Main Street
All right. So I learned last year, I'm a newbie to the state, Dr. Ness. We've only been around one year now. But I learned last year it gets cold here in winter. So I really enjoyed my long hot showers. And in reading for this, it's just like I shouldn't do that. Is that true? And darn it, if it is.
Dr. Rachel Ness
Yeah, everyone loves a good long, hot shower. But one of the things, not only will it save you on your energy bill, but it's going to save your skin. And so when I was trying to use people, the analogy of when you get in a hot, hot shower, think of all those natural fats and lipids in your skin and you're really melting them away. Okay? Just like when you have oil on the stove top and all those natural oils and lipids are going down the drain, okay, in your shower. So it's a good visual reminder. So not too hot, not too long, and then immediately. And then when you're in the shower, we also not going to want to use those harsh harsh soaps okay, strip away those oils. And then I say, don't even turn the fan on in your bathroom until about 1 to 2 minutes after you're out of the shower, after you've got your lotion on or your moisturizer. Because then what we can do is we can seal in all that moisture.
So we want you to do that before you turn the fan on. So even when the mirror in your bathroom still has that layer of humidity on it, that's the time to seal in that moisturizer. Okay. And then you can go ahead and turn on the fan. So I'm not saying you can have a hot shower, but let's keep it to a minimum as temperature and a minimum with time just. And then I'll go ahead.
Main Street
Yeah, and I understand that real quickly. I hadn't planned to ask this, but our sauna is a good thing or a bad thing if you're hanging in there for like 20 minutes and it gets really hot.
Dr. Rachel Ness
No. Saunas are fine for most people, you know. It's a very nice, humid, you know, environment. So no, there's no issues with it because if you're constantly going from that wet human to dry and you're not moisturizing after a sauna, that wet, dry, wet, dry, wet, dry cycle, if you're doing that, can actually dry out the skin. So if you're going to do a sauna immediately afterward, if you want to do, you can rinse off and then apply a moisturizer to lock in all that moisture to your skin. Okay, the people are not good. Or are those with who have severe rosacea or a very vaso reactive. It can flare their vaso reactive diseases and they can get red, and they can actually develop pimples and outbreaks from that intense heat.
Main Street
What about diet and skin health? They must be related.
Dr. Rachel Ness
Yeah. And they've done study after study in certain even diseases. We know that certain like high glycemic index diet. So high sugary and processed foods can actually increase inflammation inside the body, but also on the skin. The skin tends to be kind of a reflection of what's going on inside the body. So having people on a low glycemic, you know, or a low inflammatory diet. So oftentimes that it tends to be more the Mediterranean diet is really great for the skin. And they've done studies how it can help with certain diseases you know, like acne psoriasis eczema and atopic dermatitis.
Main Street
Have you noticed any emerging trends and conditions, I guess, in your field that you really didn't encounter, Dr. Ness, earlier in your career, and especially here in North Dakota?
Dr. Rachel Ness
Yeah, definitely. I think that that's what's fun about the field is there's constant evolution in the field of dermatology is and other fields of medicine. I think some of the things is emerging trends. The the field of aesthetics has definitely changed over my 20 years of doing dermatology. And so there's constantly we were just demoing another facial injectable product for a skin booster that hydrates the skin this morning that we were doing a couple staff members. And so staying up to date with those trends to make sure we're meeting the needs of the consumers and the trends. So aesthetics is huge in dermatology.
So a portion of my practice is medical conditions. And then a portion of my practice is aesthetics. And so we have a lot of great providers here. And I think what we've learned is one of our our kind of mantras is, you know, we want to be able to treat the entire patient, the entire family and have a comprehensive dermatology practice under one roof. So you can actually come here and be seen as a pediatric patient versus an elderly patient and everyone in between for your medical needs and your dermatology needs and your aesthetic needs. I think other things that have really been fun in changing is constant new medications and drugs and development. As far as we have tons of biologics, injectables and other medical advances to treat atopic dermatitis and psoriasis. And so there's new medications. We were just learning. We had a presentation earlier today about a new biologic medication that we use for really patients with really, really tough eczema, any topic dermatitis that they can get injections for now. And then another huge portion of dermatology in our practice that we see with a lot of our medical providers here, we see a lot a lot of skin cancer. And so, you know, for the first.
You know, for a decade of my career, the only things that we could do for skin cancers where we had some cancer creams that we could occasionally, but mostly we're cutting out everything. There's stitches, you know, scalpels and, you know, it's procedures and surgeries. And now we have actually were one of the only practices or only dermatology clinics now in the state of North Dakota to have exist, which is a image guided superficial radiotherapy. So now so with some of my skin cancer patients, if you have particular types of skin cancers, you can actually do non-surgical interventions, you know for for skin cancers and still get some of those 98 to 99% cure rates. That's exciting. Yeah.
It's so exciting. And it's just it's it's just one other option to give our patients, especially when our patients, you know, some of these patients I've seen for 15 years. And I'll come in there and they'll say, Dr. Ness, you can do anything you want, but you're not cutting on me. You know, say, well, you just you have three new skin cancers. What do you want me to do? You know, and so it's really been fun to kind of see the evolution, you know, of the field and more treatment options, you know, for our patients. And I think that's another thing I was telling my patients, don't be fearful. Don't be fearful to come in because you think you might have a skin cancer because there's so many great options now to treat them. It's not just one option that you have now.
Main Street
Yeah, procrastination is not a good thing. I think when you're dealing with that at all. I'm curious. We all are aware of the sun and we need to protect ourselves from the sun. Are there environmental factors, maybe like pollution or even smoke from the wildfires? Etc., that are causally related to skin cancers and other skin problems?
Dr. Rachel Ness
When you think of environment like in particularly small, I mean, those are all oxidants, you know, in our body and any oxidative processes leads to aging and, you know, damage of our DNA and genetics. So environmental risk factors is huge, you know, with us. And so you've got your genetic risk factors, but then you've got you take two identical twins. And you know that I have some identical twins that have skin cancers. And then the other identical twin doesn't. And so, you know, there's a huge component to environmental, you know, differences between these two identical twins. And so yeah, so smoke, you know, other kind of oxidative processes that we're exposed to essentially if you leave your house, you're going to be exposed to some oxidative things. So there's actually some internal antioxidants that we do put some of our patients on, specially with high risk cancer patients. We put them on some internal, you know, supplements or other things to help with that oxidative process, other topical things that they can put on their skin also to help arm them against those oxidative stressors of the day, which no matter who you are, you're going to have oxidative stresses on your skin and your body every day.
Main Street
Dr. Ness, it's been a pleasure. We have more to talk about, but we're out of time for now. I hope we can maybe visit again in the future. Dr. Rachel Ness is the owner and founder of the Fargo Center for dermatology, and she is a diplomat through the American Board of Dermatology and serves as a fellow for the American Academy of Dermatology. Dr. ness, thank you so much for joining us on Main Street.
Dr. Rachel Ness
You're very welcome. It was a joy to be here today.
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