Monday, January 30, 2023

HAND SANITIZER as deodorant


Cheap! Effective! Portable!  


The Covid-19 pandemic gave humanity a new appreciation for hand sanitizers. They are now in every store, hospital, office, and household. 


But hand sanitizers do more than reduce the spread of infection. Take, for example, smelly armpits. Fact: if you eliminate the bacteria, you eliminate the odor. Soap and water will always be a mainstay, but not always convenient. Hand sanitizers prevent the odor and are highly effective substitutes when washing is not possible.


A little background: Sweat in our armpits—called apocrine sweat—becomes smelly only after resident skin bacteria called Corynebacterium break it down. The higher bacteria count in your armpits, the stronger the smell. This does not happen with normal perspiration on your body (‘eccrine’ sweat) from heat or exercise. 


The good news is that ordinary hand sanitizer, when rubbed into your armpits and allowed to air-dry, kills most of the germs so that the sweat does not become smelly. You can apply it daily, after washing, or whenever needed. 


Hand sanitizers are usually 60 to 70% alcohol (ethanol), inexpensive, easy to apply, portable and well tolerated even in the sensitive skin of the axilla (armpit). Irritation is rare with intact skin. Unscented is always best. 


How about the established alternatives? Ordinary deodorants are mostly made of fragrance that masks the smell temporarily. ‘Antiperspirant’ deodorants block sweat pores and are highly effective but are more expensive and the active ingredients (aluminum salts) can cause skin reactions. Disinfectant cleansers (iodine or chlorhexidine) are effective but can irritate the skin and are costly. Rubbing alcohol (isopropyl alcohol) would be a good alternative, though less convenient and can irritate skin. Finally, some studies have tried to replace the Corynebacterium bacteria that causes the smell, with Lactobacillus species, but this would be costly and temporary. More studies are needed.

James Shaw website






Wednesday, December 5, 2018


One of the most common dermatological MYTHS is the belief that flaky, itchy scalp, so-called dandruff, comes from washing your hair too much. The truth is the exact opposite. Read on.

 Almost 100% of patients who visit me as a dermatologist for dandruff suspect the flakes and itch are from drying out of their scalp. Patients instinctively reduce their hair washing but it doesn’t get any better. In fact, they all admit their scalp feels better the day of and day after washing, but gets worse after two or three days of NOT washing. Here’s the explanation:

Dandruff affects almost half the world population of adolescents and young adults to some degree. It affects both men and women but seems to be more common in men. Flakiness, itch, and oily scalp are the most common signs. At its worst, dandruff goes by a different name—seborrheic dermatitis and can even involve the skin of the face.

Many factors contribute: Testosterone leads to oiliness (both men and women have testosterone). Oiliness promotes microscopic yeast organisms called Malassezia. Individual immune responses lead to the inflammation (redness, itch) and discomfort. That, basically, is the package.

So how does washing hair influence the problem? The issue is this: Washing removes the flakes, the oil and the yeast organisms which in turn reduces immune reactions which ultimately reduces flakiness, itchiness and redness. The purpose is to clean your scalp, not your hair per se (the hair will get clean in the process). Use conditioners as needed.

What shampoo to use? Mere washing with plain shampoo can help, but the best anti-dandruff shampoos contain either coal tar (T-Gel®, Pentrax®), anti-fungal chemicals (Nizoral®, Cicloprox®) or cortisone-like steroids (Clobex®). Personally, I favor tar shampoos, which also happen to be the least expensive.

How often should you wash your hair? In general, the more you wash your hair, the better your scalp will feel. (Scalp skin is similar to face skin, and you don’t wash your face only once per week!) Daily hair washing is usually adequate in the setting of dandruff/seborrheic dermatitis. It depends on the severity of the condition. The important fact is that washing does not worsen the problem, it only helps.

There are cases where seeing a doctor is required. Topical prescription lotions can reduce inflammation or reduce the Malassezia yeast. Fortunately, the condition is not dangerous to your health, and tends to improve as you move from the prime of life into middle age and beyond. Something to look forward to!

And ONE MORE THING: The concept of lather, rinse, repeat is complete nonsense, falsely made up by manufacturers so that you have to buy twice as much product as you need. Once is perfectly adequate. Thank you.

Thursday, July 2, 2015

Immunity: a double-edged sword

With no immune system, we would all die young from overwhelming infections. However, the immune system is a two-edged sword. Too little and too much are both harmful.

Immune function is so hard-wired genetically that immune deficiency occurs only in the most extreme settings: HIV/AIDS, organ transplants (by intention), some lymphomas, extreme malnutrition and genetic immune deficiencies.

For example: The reason you get a cold or the flu is NOT that your immune system needs a boost, it is that your immune system is reacting appropriately to the virus you got exposed to from your kids or coworkers. With flu and colds, EXPOSURE is the issue, not immunity. If you do catch a cold, you become immune to that particular strain, but there are so many different strains, the next one you encounter could lay you low again.

The real problem in many diseases is an overactive immune system. The following common diseases develop as a result of too much immune reaction:

Poison ivy rash: immune reaction to the plant chemical on your skin
Psoriasis: aberrant immune reaction to numerous environmental exposures
Lupus: autoimmune reaction to your body’s own cells
Ulcerative colitis: genetically influenced autoimmune reaction in the intestines
Rheumatoid arthritis: autoimmune attack on joints and other tissue
Dry eye/dry mouth syndrome (Sicca): autoimmune attack on saliva and tear glands.
Peanut allergy: life threatening immune reaction to peanut ingredients
Hay fever: immune reaction to pollens
Asthma: partially genetic immune reaction to multiple inhaled allergens
Drug reactions: severe immune reactions to many drugs
Hives: immune reaction to shrimp, strawberries, drugs, etc, etc.
Eczema: genetically determined immune skin reaction causing intractable itch

How about CANCER? It is a common misconception that cancer is related to deficiency of the immune system. In most cases, gene mutations cause cancer, combined with certain environmental carcinogens like tobacco and asbestos, to name only two.
In the special setting of organ transplants, where the immune system has to be suppressed intentionally, cancer becomes a higher risk because the immune system can’t do what it does naturally: to seek out and kill abnormal cancer cells. 

Only ONE of the top ten causes of death has a direct connection to low immunity and that is HIV/AIDS. Most of the common killers have nothing to do with low immunity. Boosting your immunity (which can't be done anyway) will not decrease heart disease, stroke, lung disease, diarrheal illness, and many others. 

Much more common is too much immune response (called ‘inflammation’ and sometimes ‘auto-immune disease’). Most of the new 'biologics' advertised heavily on T.V. (Humira, Enbrel) suppress immune response. Prednisone is the most common immune suppressor.
The simple things we can do to reduce autoimmune inflammation is avoid smoking, excessive eating, alcohol, and don't abuse the sun. 

So, in short:
1. Don’t worry about boosting your immune system; living healthy is enough.
2. Understand that you cannot improve on the immune system you were born with.
3. Understand that successful treatments for the diseases listed above consist of therapies that suppress, not boost, the immune response.

Vaccines deserve special mention. Vaccines induce immunity to individual disease-causing viruses and bacteria. Polio, measles, mumps, whooping cough are the most familiar ones. The flu vaccine induces immunity to the influenza virus of that particular year only, so yearly vaccination is the rule.

Shingles is also a special case. Shingles (Herpes Zoster) develops when there is a reduction in natural immunity to the chickenpox virus. This happens with aging or severe illness. There is no proven method for an individual to avoid reduced immunity with age. Fortunately, there is now a vaccine against the virus, which is given at age 50 to 60 to literally boost that specific immunity.

Best regards,

Related links:
SHINGLES (Herpes Zoster): Baby boomers: there is hope!
"Don't Pick That Mole"--- dispelling the myth
SUN PROTECTION: Myths and truths
Hormonal Acne in Women

Tuesday, June 16, 2015

Why scabs form. Plain and Simple

by James Channing Shaw, MD

Here’s what everyone should know about open wounds and scabs:

1.     Wounds heal only in a humid environment. Dry skin cells are DEAD and cannot grow to heal the wound.
2.     Scabs form as nature's way of preventing the wound from drying out and to CREATE a moist environment UNDER THE SCAB that allows cells to multiply.
3.     The alternative to a scab is a proper covering. Open wounds heal best when COVERED. It's like a scab, only better.
4.     You can create the healing environment (and AVOID THE SCAB) by NEVER letting the wound open to the air. Ever. The oxygen comes from the blood that feeds the skin cells, not outside air directly.
5.     It takes longer for a wound to heal if allowed to form a scab, vs. a dressing.
6.     To prevent the bandage from sticking, apply an ointment (containing NO water- you have to read the label) before bandaging. ANTIBIOTIC OINTMENT has been shown to be no better than plain petroleum jelly or similar healing ointment. The most familiar products are Vaseline and Aquaphor.
7.     A bandage can be left on a clean wound for several days at a time. There is no need for daily dressing changes unless the bandage gets soaked.
8.     Open wounds RARELY BECOME INFECTED if they are cleaned before applying the dressing. Signs of infection include SIGNIFICANT increase in pain and redness several days following the injury.

Sincerely yours,

Sunday, January 20, 2013

"Don't Pick That Mole" --- dispelling the myth

My daughter recently asked, “Is it true that pulling hair out of moles or picking at moles causes them to turn into cancer?”

She was trying to help one of her girlfriends understand something her mother had pounded into her from childhood: “Don’t touch that mole! If you pick, you’ll turn it into cancer!”

So, once again I am here to dispel another myth. Hundreds of my patients have asked the same question over the years. 

The cancer in question here is melanoma. 
THE BOTTOM LINE: There is no convincing scientific evidence that picking a mole turns it into cancer (melanoma). That also applies to nicking during shaving, catching with a comb or brush, or any other trauma. Traumatized moles, however, if removed, can show abnormal features under a microscope even if they are not cancerous.

The usual scenario is that a traumatized mole might look scary for a few days but it should heal the same way traumatized skin anywhere heals, back to its normal appearance after about two weeks. If it doesn't heal, see a doctor.

The ‘moles’ we are talking about are the common type, raised slightly above the skin, regular in shape (round mostly), ranging in color from skin tone to tan-brown to darker brown, and about the size of a pea or a red bean. They can occur anywhere on the body. Moles from birth (congenital moles) can be much larger and darker, but occasionally they can look like the common moles as well.

The majority of melanomas originate from normal skin, entirely independent of moles. We know that individuals with large numbers of moles on their body, especially ones called ‘atypical’ or ‘dysplastic’ moles, have a higher risk for melanoma. This is probably based on mutated genes that affect normal skin as well as moles. The number of moles may simply be one sign of innate genetic programming or altered genes from ultraviolet light. Fortunately, there are also genes that limit the growth of most moles for a lifetime unless they also become mutated.


Melanoma is a potentially deadly cancer. One out of every eight individuals with melanoma dies from melanoma. You definitely DO NOT want to get a melanoma if you can avoid it. So the question about picking as a risk factor is an important one simply because you have control over it.

The only controllable behavior associated with both increased numbers of moles and melanoma risk is EXPOSURE TO ULTRA-VIOLET LIGHT. Ultraviolet light from sun or tanning beds has the potential to alter genes that can lead to more moles and increased risk of melanoma. Genetic studies are still in early stages, but there is enough epidemiological evidence to link ultraviolet light with melanoma in many cases (though not those that occur in skin of color).

Persons of light color (red hair, freckles, blue eyes, etc.) and those with many moles should make every effort to avoid exposure to the sun, starting in early childhood. And concerning sunscreens: don’t be fooled into thinking that they fully protect against sun damage and skin cancer. They partially protect against sunburn, so people often think they can stay out longer, which explains some of the theories that sunscreens cause skin cancer when it is really the increased sun damage in most cases.

In summary, the only real control we have to prevent melanoma is to avoid sun exposure and UV tanning beds. It does not provide complete protection, but it’s the best we have.

An important measure, while not prevention per se, is to monitor your skin with a Skin Self Exam. Look at your skin and your moles once per month approximately. If you see obvious new growth or new black color in the space of a month or two, see a doctor, get it checked. Many cases of melanoma become deadly because of delays in diagnosis. Some links:

So, in conclusion, don’t pick at your moles, monitor them regularly. And don’t be foolish in the sun.

Best regards,

Thursday, June 16, 2011

SUN PROTECTION: Myths and truths


            Summer is here, and despite growing familiarity with the concept of sun protection over recent years, misconceptions abound concerning sun safety and how best to protect yourself from the damaging effects of the sun. The causative role of the sun is indisputable in skin cancer and premature aging of the skin. Even melanoma, the most rapidly increasing cancer in white populations, is strongly associated with intermittent sun exposure.
            Here are six of the most commonly held myths surrounding sun protection.
            Myth #1: All skin types require sunscreens.
            The truth: Individuals with very fair skin (red hair, freckles, sunburn always) and fair skin (blue to hazel eyes, light skin, sunburn easily) benefit most from regular use of sunscreens. Natural pigment (i.e. melanin in the skin) is by far the most effective sunscreen. The darker a person’s skin, the greater the innate protection. Individuals with olive-colored (tan easily, rarely burn) or darker skin (never burn) have very little risk of developing the types of skin cancer that arise on sun-damaged skin. Sunscreens can help prevent further darkening after exposure to the sun, but skin cancer prevention and photo-aging is much less of an issue for individuals of color.
            Myth #2: If you use appropriate sunscreens, sun exposure is safe.
            The truth: Sunscreens mostly protect against burning rays (ultraviolet B, or UVB). Deep penetrating tanning rays (UVA) still get through to the dermis where they contribute to aging and skin cancer. The absence of sunburn with sunscreen gives a false sense of security and often translates to spending more time in direct sun. This is a potentially harmful practice, one that explains, in part, the increased incidence of melanoma that has been reported in sunscreen users.
            The correct approach, then, for preventing skin cancer and photo-damage is to use sunscreens regularly as one part of a lifestyle of sun avoidance behavior (hats, long sleeves, long pants, shade). Daily sunscreens are especially important on the face, ears, neck and hands where coverage with clothing is difficult. If your goal is getting a tan or a dose of Vitamin D, it is safer to spend short amounts of time in the sun without sunscreen, then cover up or seek an umbrella.
            Myth #3: If SPF-30 is good, SPF-60 must be twice as good.
            False. Two points are crucial here. First, SPF-4 or SPF-8 sunscreens deliver inadequate protection, but once you get to SPF-15, you achieve more than ninety-two percent protection. Increasing to SPF-30 or SPF-60 merely takes it to ninety-four or ninety-five percent. The amount and frequency of application become the important issues, as long as you are using SPF-15 or higher.
            Second, SPF grades only UVB protection (the burning rays). There is no equivalent grading system for UVA protection. One must rely on the ‘broad spectrum’ labeling to indicate UVA protection, and it is often inaccurate. The best UVA blockers are zinc oxide and titanium dioxide.
            Myth #4: You don’t need sunscreens on a cloudy day.
            The truth: Ultraviolet light intensity is not reduced on cloudy days. The rays get jumbled in the clouds, but the intensity hitting a person’s skin at ground level is the same as on a clear day. Cooler temperatures with clouds give a false sense of security which often means that people spend more time exposed without protection. Also, with ultraviolet intensity being greatest on June 21st every year in the Northern hemisphere, UV intensity in May can be the same as July, April can be the same as August, and March the same as September. Sunscreens should be used at least from March through September.
            Myth #5: Sunscreens must be applied thirty minutes before going in the sun.
            The truth: This is totally false. The chemicals and blocking agents in sunscreens are fully effective right out of the tube. In fact, the sun-blocking effects of sunscreens have been shown to be the strongest immediately after applying to the skin, and gradually fall off in strength over several hours.
            Myth #6: Only specialty clothing provides good sun protection.
            The truth: All types of clothing, when dry, protect from the skin from both UVB and UVA radiation. Of course, the tighter the weave, the better the protection. Specialty clothing manufacturers have designed excellent sun-protective clothing and have confirmed high SPF equivalency values, but the real benefits lie more in the comfort and lightness of their fabrics, not the sun protection per se.
            The exception to this rule happens when fabrics get wet. Most standard clothes, t-shirts for instance, become worthless as sun barriers when they get wet. Specialty sun-protective garments maintain their SPF when wet, and highly protective swimwear is available for children and others spending hours in the water.


Monday, June 6, 2011


In the last posting, I laid out the uncertainties of using Vitamin E directly on skin to reduce or prevent scars. In this post, I discuss the antioxidant effects of Vitamin E.

OXIDATIVE STRESS is the issue. Oxidative stress occurs when chemicals called ‘free radicals’ form naturally or following injury (surgery, smoking, sun damage). Free radicals damage DNA, destroy cell membranes, and trigger inflammation. They have been implicated in the development of skin cancer. Vitamin E neutralizes free radicals, thus protecting cells from oxidative stress.

True Vitamin E deficiency occurs only in rare diseases where dietary absorption is poor. However, a study of almost 10,000 individuals suggested that the majority of men and women in the U.S. don’t meet current recommended dietary intake of Vitamin E. In addition, studies have shown that outer layers of skin have a relative shortage of natural antioxidant protection.

THEREFORE, THE QUESTION: Does supplemental Vitamin E (orally or topically on the skin) deliver real health benefits?

THE ANSWER: Possibly.

THE EVIDENCE: Hundreds of well-designed trials have been published in which oral Vitamin E alone or in a cocktail of multiple antioxidants was used as treatment in a wide range of diseases. Some were successful, some failed.

A partial list of successes with oral Vitamin E: Eczema (atopic dermatitis); tinnitus; mucositis after chemo in kids; glaucoma; early macular degeneration; kidney damage after lithotripsy; skin barrier function; post-radiation saliva flow; recurrent embryo loss; cholesterol levels in kidney patients; vitiligo; melasma; kidney damage after contrast exposure; cardiovascular disease; mastalgia; non-alcohol fatty liver.

A partial list of failures: Sjogren’s syndrome; exercise-induced oxidative stress; drug-induced neurological side effects (tardive dyskinesia); sexual dysfunction in men; acute mountain sickness; glaucoma surgical complications; prostate cancer; fatty liver in adolescents; Down’s syndrome; throat cancer; and SKIN CANCER.

Re: failure of Vitamin E in SKIN CANCER: A huge study in France showed that dietary supplementation with a cocktail of oral Vitamin E, C, Zinc, selenium and carotene was associated with an increase in skin cancers in women but not in men. The authors speculated that the sun damage may have occurred long before the antioxidant treatment was started. They also reported prior studies showing increased melanoma risk in women who had supplemented with selenium.

The largest body of evidence with topical Vitamin E supports its use as a photo-protective agent. Many studies demonstrate that Vitamin E protects against the damaging oxidative effects of sunlight (ultraviolet light exposure). Studies have also proved that the addition of topical Vitamin C enhances the antioxidant effect of Vitamin E. Unfortunately, concentrations of Vitamin E in cosmetic products vary widely and an optimal concentration has never been established.

In summary, topical Vitamin E can help protect against sunburn and the long-term aging effects of UV. Whether it protects against skin cancer is not known. A bigger question remains, though: Is Vitamin E more effective than sunscreens and sun avoidance behavior? More studies are needed. At the present time, no dermatologist would recommend Vitamin E-containing products as substitutes for sunscreens.

  1. Vitamin E can help in the management of several medical conditions.
  2. Most of the known benefits of Vitamin E come from antioxidant properties that prevent or reduce tissue damage from inflammation.
  3. Since dietary intake of Vitamin E is often inadequate, daily supplementation in the range of 400 to 800 I.U. may be beneficial and appears to be safe.
  4. Topical Vitamin E can help prevent oxidative stress in the skin, and may be helpful in treating vitiligo (pigment loss) and melasma (increased pigment).
  5. Vitamin C enhances the antioxidant effect of Vitamin E.
  6. Although skin reactions can occur with topical Vitamin E, they are not common.

Disclaimer: Dr. Shaw has no financial conflicts of interest pertaining to the products discussed in this blog post.

NEXT: Sun protection: myths and truths.