Topical Chemotherapy for your Skin

Explaining Tawny Willoughby's facebook selfie

Tawny Willoughby during treatment on the Left and  After on the Right. Photo from

Tawny Willoughby during treatment on the Left and After on the Right. Photo from

Last May, Tawny Willoughby rocked facebook and news media with a selfie of her skin cancer treatment.  You may have already seen her photo.

Many of my patients have asked me what was going on in this photo.   So, I thought I would give a little explanation.  I actually contacted Tawny myself, and she graciously responded to confirm details of her treatment.  Actually, I see patients who have this treatment every week and her response is very common.  In fact, I have been through one of these treatments myself.  I dug up some old photos that noone has seen before because that was 2008 and the word “selfie” wasn’t in anyone’s vocabulary.  See the photo of my neck and chest.

Photo of Dr Rosenberger's chest when she used Carac cream in 2008

Photo of Dr Rosenberger’s chest when she used Carac cream in 2008

So here’s the scoop…

What is this treatment and why would we do this to someone?  Patients like Tawny and myself can treat a large area of sun-damaged skin to try to bring out and treat any damaged areas that are both visible and not visible to the naked eye.  Dermatologists use a number of different chemotherapeutic creams to treat in this way. The most common creams used in this way are Carac, Efudex, 5-flurouracil, imiquimod, Aldara, Zyclara, and Picato.  The creams are applied from 2-30 days (depending on which cream) to an area of suspected sun damage.  Any spots that are pre-cancerous or cancerous will get red, scabby and crusty as you see in the photos.  Yes, all the spots that are red and crusted are AT LEAST precancerous.  Following the treatment course, the areas are allowed to heal.  It usually does a GREAT JOB and most patients are delighted with the long term result.  The skin is smoother, softer, healthier and younger looking once it heals.  But YES, IT LOOKS TERRIBLE in the meantime.

Is there another way?  Yes! We usually use these creams to treat precancerous spots called actinic keratosis.  Some of them are also FDA to treat superficial skin cancers including superficial basal cell carcinoma.  Another method to treat precancerous spots is a treatment called photodynamic therapy.  With this procedure a patient comes into the office and a liquid called Levulan is applied to the affected area (usually the face or scalp).  The Levulan is preferentially absorbed by the abnormal cells while it incubates for 45-90 minutes.  Then, the patient sits in front of a blue light for about 15 minutes.  There is an interaction between the light and the Levulan solution in the abnormal skin cells that causes death to the abnormal cells.  With this treatment, there is less down time.  The patient will have what appears to be a decent sunburn that peels for about 7 days.  The good news is that the patient is much more presentable than when a patient uses one of the creams.  We perform this procedure in the office.  It is covered by Medicare and most major insurers now.  This procedure also provides an excellent cosmetic outcome.

So, if you are concerned that you have damaged your skin and you would like to consider one of these treatments, we can discuss that in the office.  Personally, I have used the cream on my neck and chest years ago as you see above.  Plus, I usually do photodynamic therapy on my face once or twice a year.

If you would like to learn more about precancerous actinic keratoses and wonder if you have some, check out this link from the AAD and these images on google or the handout on our medical education page.


Have you personally had one of these treatments?  If so, please feel free to share your photos and experience by commenting here on our blog or facebook.  Let your story, like Tawny’s, be an inspiration and education for those who are listening. 


Tan Fat Looks Better Than White Fat

Sunless Tanner Tips

tone it tan it“Tan fat looks better than white fat.”  When listening to a recent teaching by a very wise respected biblical teacher, she uttered this non-biblical, yet awesome truth.  For those of you who have heard Beth Moore speak, the phrase was preceded by a HILARIOUS story and followed by a roar of laughter and nodding women.  In fact, when I googled this phrase just now, I got 11.2 million hits.  Seriously, what is a pale skinned, freckled, skin cancer surviving dermatologist to do?  Apply sunless tanner, because… who doesn’t want to look skinnier?


And so, I harken back to the beginning days of sunless tanner and spray tans. Girls in my high school would come to school with orange hands and even more orange bodies.  For those of you who are around my age, you will remember the Friends’ episode where Ross had a major spray tan mishap.  For those who are too young or too old to remember the episode… check it out here.  I promise, it will make you laugh.

So, how can we look a little less white and a little skinnier?  Here are some tips and facts on sunless tanning.

Sunless tanners come in a variety of vehicles… cream, personal spray, mousse, gel, towelettes and many more.  In almost all cases the active ingredient is dihydroxyacetone.  According to Wikipedia..” It is often derived from plant sources such as beets and sugar cane, and by the fermentation of glycerin.” So, it is very safe for everyone.  I even used them when pregnant and nursing.  Erythrulose is the other most common active ingredient.  Both interact with the proteins in the outer layer of the skin and cause discoloration.  A few studies have suggested that the skin is a little more sensitive to UV damage within 24 hours of application.  So, to be safe, apply >24 hours prior to expected significant sun exposure.  Intensity of coloration is directly related to the concentration of the active ingredient in the product.

Here’s a personal opinion.  Why waste your time with the “gradual tan” formulas.  What a marketing triumph!  They are selling a highly diluted product that needs to be used 5-6 times more to get the same result.  I have no time or patience.  Give it to me straight up.


1 – Exfoliate – We have some products available in the office containing glycolic and alpha hydroxy acids to help exfoliate prior to using sunless tanner.  ZO Skin Health Oraser® Body Emulsion Plus  and  ZO Medical  GLYCOGENT™ Exfoliation Accelerator. 

2- Find one that matches your skin –Go ahead and just buy a few.  Try a few of them in a test spot on your arm, make a mental note of which one is where, wait 24 hours and then pick one that matches best.  Return the rest. (Did I just say that?).  Or throw the rest away and waste your money.  You pick. My favorite… L’Oreal Paris Sublime Bronze Self-Tanning Body Towelettes in Medium.

3- Apply after showering and shaving.  Don’t get dressed for a few minutes, and let it dry.

4- Examine thoroughly and repeat.  Look it over really well and plan to repeat to even it out.

I have only had a few spray tans.  While I am a little more coordinated than Ross, I personally would rather do it at home.  For me, the at home version applies more evenly, wears off more evenly and lasts longer. I find the spray discolors my clothes more, costs a lot more and is a sticky mess. Save some money and do it yourself.

What is your favorite method and product for sunless tanner?  Have you had a sunless tanning mishap? You can comment on the blog or on our facebook page.  I love to laugh and learn!

Inlcuded below is a video from the AAD on applying self-tanner as well.


Join us for a fun day of cosmetic procedures, product specials, refreshments, door prizes and more!


We have been doing these cosmetic days quarterly this past year.  Each time we have a number of specials on both products and procedures.

Anyone can walk in to buy products, but to have a procedure done at the special pricing for that day, you must have an appointment.

FOLLOW US and LIKE our facebook page for the specials for that day.  We will announce the specials later this week.

Any questions, call the office, for more details.

Date: August 6, 2015
Event: Cosmetic Day August 6th, 2015
Topic: Cosmetic Day
Public: Public

Blueberry Picking + Merry Go Rounds=Recipe for FUN!

Simple, humorous, family fun!


Picking Blueberries at Blueberry Ridge

So, today Dave suggested we go blueberry picking.  The girls and I went last year to Blueberry Ridge Farms, so we thought we would try it again.  Last year I wandered there on a whim,  following blue “Blueberries U Pick Em” signs WAY off the beaten path to a beautiful clearing atop Bunner’s Ridge.  You can check out their facebook page.     It is lovely.  Just right.  Compared to picking strawberries, it is nice because you are standing up.  Sounds silly, but true.  Also, it is open and easy enough that the kids can really do their own thing.  I highly recommend it.

Now, the one downside to Blueberry Ridge Farms is that it is pretty close to the middle of nowhere (which also is a major part of its charm).  While driving today, Lily said, “What state are we in?” We were way further into the country than she had been lately. (We had actually missed the turn off at this point and had gone about a mile down a gravel road the wrong way.)  Dave replied, “a state of dismay”.  Lily pondered it for a moment, “No, I think it is Maryland”, she said.  So, by the time we got there, Dave had a few queasy passengers, as we all tend to get a little carsick.

Let me backtrack before I finish the story…last year we went strawberry picking at Higson’s Farm in Wiley Ford, WV.  While there, little Ella ate a few too many strawberries.  That night, we all regretted how many strawberries she ate.  Today, while strawberry picking, I reminded Ella of that experience.  “That was NOT GOOD” she said upon reminiscing.  Apparently, my warning was a little too late….


Picking strawberries last year at Higson’s Farm in Wiley Ford


Merry Go Round at Bunner’s Ridge

On the way home we stopped at a little old fashioned playground at Bunner’s Ridge.  I actually like this playground a lot.  It is empty, quiet, and reminds me of playgrounds when I was little.  The slide and merry go round are the kind that they had at Wiley Ford Elementary School when I was a kid.  You don’t see these kinds of merry go rounds much anymore.  Probably because they are dangerous, and they make kids sick.  But they are sooo much fun!

So, after a dizzying time at the playground, we hop back in the car for the ride home.  On the way into town, Dave decided to stop at the bank and leave us in the car.  Then it started.  Ella was sick, very sick.  Too many blueberries, and too many go rounds on the merry go round.  I am never quite prepared for these events, so I had to think fast.  See that hat that was on Lily’s head.  Turns out it makes a great catch basin.  So, for all of you who make fun of our hats, you never know when a hat will come in handy.

Back home, we were all bathed, hair washed and ready for more.  So, we made a delicious blueberry cobbler.  Just now thinking I should’ve taken a picture, but it is 2/3 gone now.  It is an adaptation of one by Ree Drummond.  The original is on my Pinterest Page .

So, if you still have an appetite and you make it out to Blueberry Ridge, this is a great way to devour those blueberries.  If you have any great blueberry recipes you’d like to share, you can comment here or on our facebook page.

Blueberry Cobbler

  • 1 stick Butter
  • 1-1/4 cup Sugar
  • 1 cup All Purpose Flour
  • 1 ½ tsp Baking Powder
  • ¼ tsp salt
  • 1 cup Milk
  • 2 cups Blueberries


Melt butter in a microwavable dish. Pour 1 cup of sugar and flour, baking powder and salt into a mixing bowl, whisking in milk. Mix well. Then, pour in melted butter and whisk it all well together.  Now rinse and pat dry the blueberries. Pour the batter into the buttered baking dish. Sprinkle blueberries over the top of the batter; distributing evenly. Sprinkle ¼ cup sugar over the top.

Bake in the oven at 350 degrees for 1 hour, or until golden and bubbly. If you desire, sprinkle an additional teaspoon of sugar over the cobbler 10 minutes before it’s done.

Adapted from Ree Drummond Blackberry Cobbler #1.