Dermatology in primary medicine

How Skin Care Impacts the Elderly
Interview Dr Teresa Moreno

Dermatology in Primary Care
How skin care impacts the older adult.

Dermatología en la medicina primaria  Como impacta el cuidado de la piel en el Adulto Mayor

Where did your vocation for medicine come from?

Since I was very young I had an inclination for healing people. Igrew up in the province of Cienfuegos, far from the center of the city, and I always felt admiration for the neighborhood doctor (that’s what we called him), for the dedication with which he visited and attended all his patients and their families. Over time my admiration changed and one day I realized that I really wanted to be like him.

I started my career in 1993 at the University of Medical Sciences of Cienfuegos: Dr. Raúl Dorticós Torrado, where I met wonderful professors, students, who helped me and taught me in an incredible way. During my first year of my career I became pregnant at a very young age, becoming a single mother. It was very difficult to fulfill the role of student and mother at the same time, and on several occasions I had to take my daughter with me to college as so many single mothers who want to get ahead have done.

How did you get to the United States?

In 1998 I had information about the United States Visa Lottery, I applied with illusion to achieve my dream of having a better life for my family. In 2000 I was chosen as a visa winner, but it was not until 2007 that I was able to travel to this great country.

What has been your professional development in the United States?

In the United States I worked as a supermarket cashier, beauty and weight loss products salesperson, medical assistant, nursing assistant.

In 2010, while I was in the middle of my career, my second daughter was born, I had the help of my husband and eldest daughter who helped me with her care while I completed my studies at the Ana G. Mendez University where I obtained the degree of APRN (Advanced Practice Nurse). In 2015 I graduated with honors in the specialty of Family Medicine and did a subspecialty in Dermatology. I subsequently completed my Doctorate in Family Medicine at Grand Canyon University in 2020- 2021.

In 2016 I opened my office: Paradise Medical Center, the road has been complex, but I have had the support of my family and many people who have contributed a lot in my professional growth.

Why specialize in the elderly?

Not only did a part of my life stay in Cuba, but also one of the most important people for me, my father, who was sick with lung cancer.

I think that the feeling of not being able to take care of my father and be with him during that difficult time gave me a genuine interest in the elderly; taking care of them made me feel useful and fulfilled. During all this period I have dedicated my career to them, I have learned to see life differently and the love for what I do makes my work my raison d’être. I look back and I can only feel gratitude and pride for everything I have achieved and sacrificed to get where I am today.

Why the inclination for Dermatology and its specific interest in the elderly?

Dermatology has always caught my attention, I consider it a beautiful and interesting specialty, which goes beyond what we see, but, it was not until 2015 that I met an extraordinary doctor: Dr. Avelino Guiribitey, a renowned Dermatologist from my country (Cuba) who here in Miami practiced as such, He was a very special person in my life, not only gave me the opportunity to work with him, but he guided me, he taught me and part of what I am I owe it to him.

It has been many years of study and dedication, study the structure of the skin, analyze its functioning, prevent, diagnose and treat disorders that may occur in it is very complex, having knowledge of general medicine has helped me a lot in my development in this specialty hence my inclination has been directly to Clinical Dermatology dedicating myself to prevention, diagnosis and treatment of skin pathologies, especially of the elderly, making home visits, either in their own home or in the facilities where they live, commonly called Home or ALF, because it is a sensitive, fragile and vulnerable population at risk of developing skin diseases.

In 2016 I had the opportunity to open my own clinic, it was then that I thought I wanted something different, I wanted to take care of my elders in a more complete way, where we could evaluate not only the skin but also their body, because it is worth noting that many skin diseases come from internal ailments. Integrating dermatology into primary medicine has been a challenge for me.

What is Primary Care Medicine and how it is applied at Paradise Medical Center?

Primary Medicine is the comprehensive, basic and essential medical care provided to patients in non-emergency situations, it is centered on the person from a family approach.

At Paradise Medical Center each of our doctors is not only focused on treating our patients’ conditions, preventing complications or the development of chronic diseases, but we also focus on education and teaching healthy lifestyle choices, we are committed to the health of people before they are sick, in complete coordination with other specialists and family members for the well being of our patients.

Just as we educate our patients regarding Diabetes, HTN, Hypercholesterolemia, alcohol abuse, smoking, it is important to educate on how to take care of the skin, what is skin cancer, how to prevent skin cancer, what are the most common diseases in the elderly, it is important to keep in mind that as we age, the risk of developing cardiovascular, metabolic and neoplastic processes increases, likewise, the risk of developing dermatological diseases increases.

What are the most common skin diseases in the elderly?

In my experience treating elderly patients the most common diseases have been: Xerosis, Pruritus, Senile purpura, Lentigines, Lichen sclerosus and atrophic, Benign tumors: seborrheic keratoses, Premalignant lesions: actinic keratoses, Bowen’s disease, Infectious diseases: dermatophytosis and herpes zoster, Blistering diseases: bullous pemphigoid, Immunologically based diseases: contact dermatitis, atopic dermatitis, vitiligo, psoriasis, lichen simplex chronicus, pressure ulcers, venous ulcers, arterial ulcers, scabies.

Cutaneous neoplasms in the older adult
The most common neoplasms in the elderly are Basal cell carcinoma, Spine cell carcinoma and melanoma. The cumulative effect of solar radiation is expressed more strongly in elderly patients.

Prevention of skin aging
Although it is true that we cannot be young forever, it is possible to reverse skin photo-aging and prevent the development of diseases.
• By living a healthy life
• Limit the time you are exposed to the sun by avoiding peak hours when the sun’s rays are strongest. For example, between 10 a.m. and 4 p.m.
• Use sunscreen. Look for a sunscreen with an SPF (sun protection factor) number of 15 or higher. It is best to choose sunscreens that say “broad spectrum” on the label.
• Apply sunscreen 15 to 30 minutes before going out. Sunscreen should be reapplied at least every 2 hours. Consistent use of photoprotection is one of the most important measures to reverse photodamage and prevent the development of skin cancer.

• Moisturize the skin of our elderly on a daily basis
• Avoid prolonged baths with very hot water.
• Keep their skin dry and change their clothes daily.
• Change their position at least every 2-3 hours to avoid the development of pressure ulcers.
• Use mild soaps for personal hygiene.
• Practice regular physical exercise to stimulate the circulatory system.
• Increase the intake of fruits and vegetables in the diet.
• Monitor any lesion observing: asymmetry, borders, color, diameter and evolution, in case of any change always go to the doctor for re-evaluation.
• It is advisable to perform an annual routine checkup of your skin.

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