Prime Time Replay:
Drs. Arthur and Linda Balin
on the Mysteries of the Skin
MsgId: *infinities(1)
Date: Sun Jun 22 20:58:29 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
Good evening and welcome to OMNI's INFINITIES Chat. Tonight our guests are Arthur Balin, M.D., Ph.D., and Loretta Pratt Balin, M.D., authors of the fascinating new book, THE LIFE OF THE SKIN- - What It Hides, What It Reveals, and What It Communicates (Bantam, June 1997).Dr. Arthur Balin is one of the foremost dermatologists and geriatricians in the country, is board certified in six medical specialties, and focuses on treatment for skin cancer, wound healing and the problems of aging skin. Dr. Loretta Balin is a fellow in investigative dermatology at the Rockefeller University and specializes in cosmetic dermatology and women's skin problems. The two Drs. Balin are share a joint practice.
As soon as the Drs. Balin arrive, we'll begin our Chat tonight.
MsgId: *infinities(5)
Date: Sun Jun 22 21:06:45 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
Hi, we're here.
MsgId: *infinities(8)
Date: Sun Jun 22 21:07:50 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
Glad you could make it! :D Your book is an eye-opener about the complexity of skin, something most of us take for granted. Many people aren't aware the skin is actually the largest organ of the body. Can you tell us a bit, please, about what the skin does - - besides just keeping our parts from disassembling?What is the greatest danger to skin health we face today?
MsgId: *infinities(11)
Date: Sun Jun 22 21:09:06 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
First, we'd like to say that our book is a book of stories about patients -- but the medicine is there, too. The skin is not just a sausage casing. It is the interface between the external world and our internal bodies. The skin is the largest sexual organ of the body. It is expressive and receptive. It is important to the immune system, recognizing and presenting the external world to our internal body. We receive sensory information and stimuli through our skin. There are millions of nerve endings in our skin. Our skin is critical in regulating our body temperature. The greatest threat to our skin is sunlight.
MsgId: *infinities(17)
Date: Sun Jun 22 21:12:34 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
Most people wouldn't think of the skin in terms of a sexual organ... that's an interesting point.
MsgId: *infinities(19)
Date: Sun Jun 22 21:14:25 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
Yes --the skin is an organ of sexual attraction and a sexual-receptive organ, through touch and feel. The skin also has pheremones and body hair, all sexual attractants. It is expressive and receptive sexually.
MsgId: *infinities(20)
Date: Sun Jun 22 21:14:42 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
Question: You said "recognizing" -- how does the skin recognize, or "see"?
MsgId: *infinities(22)
Date: Sun Jun 22 21:16:16 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
There are millions of nerve endings all throughout the skin. These transduce external sensory signals. For instance, if a person walks into a room and disturbs the airflow, that changed air flow can hit the hairs on one side of a person and indicate the person has entered. We don't often think of this as a sense, but it is. In addition, the skin has some receptors that just transmit pressure, others just for temperature. Some transmit just light touch, others deep pain, etc.
MsgId: *infinities(26)
Date: Sun Jun 22 21:19:23 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
It's an amazingly complex organ, indeed. When people lose ability to sense touch, not only in fingers and hands but in other body parts, does the skin have a way to compensate? Is the sensory ability of skin, which you've just described, the reason visually impaired people can learn to "see" without using their eyes?
MsgId: *infinities(28)
Date: Sun Jun 22 21:22:25 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
In terms of loss of sense of touch, we see that only in certain circumstances: In cases of diabetes, for instance. In diabetes, the diabetic process causes the blood vessels to clog up with advanced "glycosylation" end-products, which cause the blood vessels to clog up and thereby kill the nerves that they feed. The result: the toes, the feet, the lower legs may loose sensation. When that happens, people are susceptible to injury. Ulcers and gangrene can develop. The skin has no way of compensating for this.As to your second question -- Is the sensory ability of skin the reason visually impaired people can learn to "see" without using their eyes? -- the answer is, yes, it is. We all have these abilities, but the brain isn't trained to use them unless we really need them.
MsgId: *infinities(32)
Date: Sun Jun 22 21:24:44 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
The same would apply to neurological diseases that rob sensory function, such as Charcot Marie Tooth or HNPP, wouldn't it?
MsgId: *infinities(33)
Date: Sun Jun 22 21:25:56 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
Yes, the diabetes example would extend to all diseases where neurologic sensation is impaired in the skin.
MsgId: *infinities(34)
Date: Sun Jun 22 21:26:32 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
The stories that fill your book are so warm and rich, it's hard to choose just one favorite but I must admit I was particularly fond of the story of your daughter's birth. Could you talk a bit about infant skin and skin problems in newborn, please?
MsgId: *infinities(37)
Date: Sun Jun 22 21:27:54 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
Infant skin does not fully function, as does adult skin, until about age two. Infants also don't sweat for the first two to three days of life. Because of this, you must be careful of their environment. You want to regulate their temperature. They can get overheated if they're too bundled up. They can be chilled, so you must make sure the bath temperature is just right. We recommend that for the first six months of life, they not be exposed to the sun without protective clothing. They cannot use sunscreen until they are at least six months old. Baby skin absorbs chemicals readily. That's why you want to use as little lotion or cream as possible.
MsgId: *infinities(40)
Date: Sun Jun 22 21:32:08 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
Are the baby lotions, petroleum jelly and similar products parents traditionally used on babies dangerous?
MsgId: *infinities(41)
Date: Sun Jun 22 21:33:18 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
Parents have long used many creams and lotions on young babies, but these are not needed. They can occlude the sweat ducts, causing the baby to over heat. When the baby can't sweat, blood flows to the surface of the skin, causing more overheating.
MsgId: *infinities(42)
Date: Sun Jun 22 21:33:47 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
Scent is something we don't usually think of when we think about skin but in your book, you've spoken of babies and mothers being able to recognize each other immediately merely by recognizing the scent of their skin. How does that happen?
MsgId: *infinities(43)
Date: Sun Jun 22 21:37:46 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
Actually, this phenomenon is not well-understood. We do know that babies CAN recognize their mothers through the sense of smell. This is likely due to pheremones --a chemical leaving through the skin.
MsgId: *infinities(44)
Date: Sun Jun 22 21:38:21 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
A complex issue described through stories of real cases featured in your book is the mind's effect on skin health. You described a woman who believed she was losing her hair, and another who thought she could excise scabies but cutting her toes with a razor blade. How do you as doctors separate the mental from physical skin problems?
MsgId: *infinities(45)
Date: Sun Jun 22 21:41:14 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
First we listen to our patient's complaints, then we use our medical tools -- including our eyes and lab tests -- to determine whether or not there is a physical basis for the complaint. If no external or internal problem is found, we consider a psychological explanation. The patient with the hair loss had a real psychological illness, called body dysmorphic disorder, a condition where the patient does not have a realistic view of their own appearance. Oftentimes, this disorder is manifested in feelings of looking grotesque, and impacts their social life to the point where they are unable to hold jobs or function normally. The patient who thought she had scabies had a condition called monosymptomatic hypochondriasis. As the name implies, it is a form of hypochondria in which the patient settles on a single symptom, in this case, scabies.
MsgId: *infinities(46)
Date: Sun Jun 22 21:41:52 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
On a lighter note, you've said the skin is the heaviest organ of the human body. Is it possible to say what the average person's skin weighs?
MsgId: *infinities(49)
Date: Sun Jun 22 21:46:13 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
For the average person, skin weighs about five pounds.
MsgId: *infinities(50)
Date: Sun Jun 22 21:46:15 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
"Body dysmorphic disorder" (the hair loss case) sounds as though it could be related to the body image problems seen in anorexic and bulimic women.
MsgId: *infinities(51)
Date: Sun Jun 22 21:47:47 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
Yes, there is a connection. They are related disorders.
MsgId: *infinities(52)
Date: Sun Jun 22 21:48:33 EDT 1997
From: guest At: 152.163.206.21
Doctor Balin, is there anything a dermatologist could do for someone who has anorexia?
MsgId: *infinities(54)
Date: Sun Jun 22 21:49:33 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
No, anorexics must seek help from people trained specifically in treating their disorder.
MsgId: *infinities(53)
Date: Sun Jun 22 21:49:28 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
That brings us to the question of cosmetic surgery, which can be a godsend to some, and an overused crutch to others. Is there a guideline you use or recommend to patients who are considering cosmetic surgery -- something that would help them make intelligent, informed decisions?
MsgId: *infinities(56)
Date: Sun Jun 22 21:51:38 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
We do a lot of cosmetic surgery. The important thing is for people to have realistic expectations about what can be achieved. Talking to patients and looking at before and after photos of other patients can be helpful. The main thing is to understand the patient's desires and expectations. What we can do is less important than where they are coming from.
MsgId: *infinities(57)
Date: Sun Jun 22 21:52:25 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
How valuable a tool is computer imaging for prospective cosmetic surgery patients?
MsgId: *infinities(58)
Date: Sun Jun 22 21:55:15 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
Computer imaging has limited value. For some procedures, it may be of some use. For instance, for those who do rhinoplasty (nose job) or liposuction, computer imaging may provide an idea of the outcome. But it can also be misleading.
MsgId: *infinities(59)
Date: Sun Jun 22 21:55:46 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
Earlier you mentioned that the sun is the greatest threat to healthy skin. Are we in the USA getting too much sun exposure?
MsgId: *infinities(60)
Date: Sun Jun 22 21:57:12 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
The answer is yes. This year 1.3 million skin cancers were diagnosed in the US. Almost all are due to overexposure to the Sun. Premature aging is the result of overexposure to the Sun as well. There are more skin cancer than all other cancers combined.
MsgId: *infinities(62)
Date: Sun Jun 22 21:59:22 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
Dr. Arthur Balin and Dr. Loretta Pratt Balin, we've come to the end of our hour much too soon... I wish we had more time to pursue this complex topic....Thank you very much for a truly fascinating conference, and for creating a wonderfully entertaining and enlightening book. You've been very generous to give us this much time and such wonderful information. Thank you so much for being here tonight!
MsgId: *infinities(64)
Date: Sun Jun 22 22:01:00 EDT 1997
From: Arthur_Balin_and_Loretta_Pratt_Balin At: 168.100.204.58
Thanks for interviewing us. We think everyone can enjoy reading our book, and learn something about saving their skin in the process.
MsgId: *infinities(65)
Date: Sun Jun 22 22:01:31 EDT 1997
From: OMNI_Noonan At: 152.171.43.20
I certainly agree with that -- the book is very reader-friendly. It is full of great material and I heartily recommend it to all our OMNI Chat visitors. Folks, that's all for this evening, but be sure to tune in to the next INFINITIES chat and check OMNI Internet's Live Shows every night for more great topics. Good night!
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